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QUOTATION SHEET

Form for:

REPRESENTATIVE'S/CLIENT'S NAME:

Phone Number:

Email Address:

Turnaround Time: If longer, please specify:

Dictation Device: Other systems:

Is there an existing unit? Yes No

Mode of Transmittal:

Currently Using/Existing? Yes No

Estimated Volume Per Month

Organization Size: # of health care professionals in the group

Average Lines: Lines/mo. each Lines/mo. each

OR

Average Files: files per day work days per month minutes per file

Average Dictation Rate:

lines per month: group

Volume Used: lines per month

Area of Discipline: General Practictioner Specialty Physician

Nature of Dictation: Letters Office Notes Hospital/Clinic Reports Any Combination

Patient Name and Referral Addresses

E-Copy Fax Copy Spell Name and Address in Dictation

Corrections

Transcribe as dictated (verbatim) Correct errors of dictators (obvious errors) Flag questionable dictations

Quality of Dictation

Good Average Poor Difficult

Origin of Work

Should pass a US quality control officer All work done in the Philippines

Please rank level of importance (4 as the highest):

Quality

Customer Support

Turn Around Time

Price