Please enable JavaScript in your browser to complete this form.Contact Information - Step 1 of 3Quick IT Check For Your ClinicAs we work to streamline IT support across our region, we’re gathering a quick snapshot of each clinic’s current setup. This will help us reduce costs, improve support, and ensure everything is running smoothly. Please take a few minutes to complete the questions below:Name of Individual Completing This Form *FirstLastEmail Address of Individual Completing Form *We will only use this email to contact you if we have any follow-up questions pertaining to this submissionFacility Name *Facility Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFacility PhoneNextSave and Resume LaterDo you currently have an IT provider?Yes (As Needed / Break-Fix)Yes (Contract)NoWhat is Your Current IT Provider's Name?When Something Breaks, How Quickly Do You Typically Get Support?Same Day1-2 DaysSeveral DaysVaries / UnsureWe Typically Fix Issues InternallyWhat are Your Monthly IT Costs?Enter Dollar Amount.When Does Your IT Provider's Contract End?If No, How Many Hours are Staff Spending Troubleshooting Technology Each Week? Selected Value: 1How Many Workstations (Computers, Laptops) are in Your Clinic? *Enter Number of Devices.How Many Tablets (iPads, Chromebooks, etc) are in Your Clinic? *Enter Number of Devices.How Many Servers are in Your Clinic?Enter Number of Devices.Is Your PIMS (Practice Management Software)Cloud-basedServer-basedUnsureDo You Currently Have AntiVirus Protection?YesNoUnsureDo You Currently Have a Data Backup in Place?YesNoUnsureWhat is your Biggest IT Frustration Right Now?NextSave and Resume LaterUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmitSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form.Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link Our PartnersHow to find us6712 Benjamin Rd Suite 800 Tampa, FL 33634888.455.7883 (Call or text)813.464.8132help@putefix.comConnectContact our crew with questions, comments or just to have a coffee and Scooby snack with your furry family members.Contact us
