Tele Radiology Enquiry
  *  Facility Name :  
  *  Contact Person's Name :  
  *  E-mail address :  
  *  Phone Number (xxx) xxx-xxxx :  
     Mobile Number :  
     Fax Number (xxx) xxx-xxxx :  
  *  How many studies per day on average would
      you need to have analysed ?  
  * What is the modality & software used?  
    Would you need us to also do reports with
      each study?  
    Is 1-2 day turnaround time post reception of
      your study adequate?  
    Does your facility have internet access?  
    What is the present image format?  
     How would you prefer we contact you?