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Physician Demo
Please provide your contact information prior to taking the demonstration. You will then be taken to a special demo version of the internet site, www.visitnote.com, which is where you would send your patients to take a medical history, after you sign up for Medical Relevance. THE DEMO VERSION, HOWEVER, WILL ALLOW YOU TO ENTER ANY ACCESS CODE AND ANY FUTURE APPOINTMENT DATE/TIME TO TAKE THE HISTORY. After taking a history, you will be allowed to view the output and print it. (The real www.visitnote.com site requires a valid physician access code, and the output would be sent directly to the physician's office.)

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First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Postal Code:

Phone Number 1:

Ext:

Phone Number 2:

Ext:

Email Address:

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