Scheduling Form2018-08-29T08:35:36-05:00







Thank you for your interest in Synct!

Please provide some information about you and your organization so that we are prepared for our discussion. After completing the form below, you will be redirected to the scheduling page so that you can schedule a personal demo.


Name*
Title*
Organization*
Address*
City/ST/Zip*
Email Address*
Office Phone*
Mobile*
Practice Website URL Address*
Practice Affiliation*
Number of Physicians/Providers in your practice*
What EMR do you use in your practice?*
What would you like to improve about your practice? (select all that apply)
Offer Patients Telemedicine OptionsReduce Patient Telephone Calls to the Office for CareIncrease revenueImprove office efficiencyWebsite/Internet PresenceGain New PatientsRetain Existing PatientsCommunity OutreachOther

What would you like to improve about your practice?

What services of Synct interest you?
Synct Telemedicine Software to connect to your patientsSynct Video ConferencingWebsite Services and Development to improve/create your web presenceCustomized Landing and Login Pages just for your practiceWhite-Labeled Mobile Apps to give you a professional presence in the App store

How did you learn about Synct?FacebookTwitterInstagramLinkedInSponsored EventPatientColleagueOther

Please provide the name of your colleague so we can thank them!
How did you learn about Synct?

What other information would you like to share?