Clearview Veterinary Imaging-New Veterinarian/Clinic form
For veterinarian/veterinary clinics ONLY.
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What is your name? *
What is your role at your practice? *
What is your practice's name? *
What is your practice's address? *
What is your practice's phone number? *
What is your practice's best communication email? *
What is your practice's accounts payable contact? *
What is your practice's accounts payable email? *
Any other pertinent information for billing?
Which practice management software do you use?
Which imaging modalities are you looking at tele-specialty services for? (check all that apply)
Do you currently have a PACS system and if so which one?  
I, as a representative of my practice, understand that as a veterinary practice and for any associated practitioners affiliated with said clinic, requesting  consultation with a telespecialist, said practice will be responsible for all charges accrued by provided consultation services. Invoices will be generated at the end of every month and due in 30 days of receipt data.
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