Free Medical Transcription Trial

Physician/Clinic/Hospital Name
Medical Speciality*	Allergy/Immunology Arthritis/Rheumatology Bariatrics Cardiology Cardiovascular Chiropractic Dermatology Emergency Medicine Endocrinology Family/Primary Care Forensic Medicine Gastroenterology Genetics Geriatrics Obstetrics/Gynecology Hematology/Oncology IME/PeerReview InfectiousDisease/AIDS Internal Medicine Neonatology Nephrology Neurology Occupational Medicine Occupational Therapy Ophthalmology Oromaxillofacial Orthopedics Osteopathy Otolaryngology Pathology/Lab Pediatrics Physical Rehab Med Physical Therapy Podiatry Psychiatry Psychology Pulmonology Radiation Oncology Radiology Reproductive Medicine Social Work Speech Therapy Surgery-General Surgery-Hand Surgery-Neuro Surgery-Ortho Surgery-Pediatric Surgery-Plastic Surgery-Thoracic Surgery-Vascular Urology Medical Speciality
Street Address
City
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Zip Code / Postal Code
Contact Name
Country	Select Your Country United States United Kingdom Canada
Title	Your Title Mr. Ms. Dr.
Position
Telephone Number*
Your E-mail*
Average weekly dictation volume (minutes)	<250 <500 <1000 <5000 5000+ Weekly Dictation
Requested Turn-around Time	<24 hrs <36 hrs <48 hrs <72 hrs 72 hrs + Turnaround time
Method of Dictation	Hand held digital recorder Existing dictation system at my practice Other digital recording method Tapes Remote phone-in Open to suggestions
WPW Software	MS Word WordPerfect Other Doesn't matter
Additional Comments
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