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Elvera Works Client Discovery Form

Full Name

Your Email

Your Mobile #

Clinic/Practice Name

Practice Address

Practice Business #

Practice Website


What type of practice do you operate?

How many providers work at your location(s)?

How many other staff (non-providers) work at your location(s)?


Do you currently work with an IT provider or MSP?

Do you currently work with an IT provider or MSP?
A
B

Which systems or platforms do you currently use?

Which systems or platforms do you currently use?

Do you currently have a firewall, business-grade wifi, and/or managed switches?

Do you currently have a firewall, business-grade wifi, and/or managed switches?
A
B
C

Any recurring IT or tech issues?

Any recurring IT or tech issues?

What service(s) are you most interested in?

What service(s) are you most interested in?