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Plus91_ClientRequest_Form
Select the Type of Organization and Solution you would like from us.
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* Indicates required question
Name of your Organization
*
Your answer
Contact Person
*
Your answer
Address
Your answer
Contact Number
*
Your answer
Contact Email
*
Your answer
Website
Your answer
Type of Organization
*
General Clinic
Pathology / Diagnostic Lab
Clinic Chain
Hospital
Specialist / Polyclinic
Imaging Lab
Insurance Company
Pharmaceutical Company
Other:
Please select the Product / Services you are interested in?
*
EMR & Admin Clinic / Clinic Chain Solution (MediXcel - Clinics)
Lab Information System (MediXcel - Diagnostics)
Hospital Information System (MediXcel - IPD)
Patient Engagement Solution (MediXcel - CRM)
Website / Portal Design
Digital Marketing and SEO services
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