PROSPECTIVE CLIENT REQUEST FOR INFORMATION

 

 

Thank you for considering Sunset Radiology, Inc. as your teleradiology service provider. Please tell us about your practice. We will get back to you shortly.

 

 

All information will be kept strictly confidential and not shared with any third party in accordance with our privacy policy.

Your Name:
Your Email:
Group Name:
State you are located in:
Phone: 

How would you like us to contact you?     Phone   Email   Brochure

Group Website:
Group Address:
Group Phone Number:
Other Member Contact Name:
Number of Facilities:
Number of Cases Per Night: Average:      

Range:   

Desired Coverage Hours: Weekdays:       

Weekend/Holidays: 

Information Technology Contact Name:
Your top priorities in selecting a teleradiology service provider:
Other Comments or Requests:
How did you hear about Sunset Radiology, Inc.?