Name:
Address:
City:
PIN CODE:
Your e-mail address
Your Phone No: (Desk & Mobile)
DO YOU HAVE INTERNET CONNECTION?
Yes.
No.
Getting soon.
DO YOU USE PC AT HOME OR HOSPITAL?:
Hospital
Home
Both
Which of following facilities do you have?:
PC
PC with CD
PC with DVD
PC with internet
PC with Lan
Which of Following software do you have?:
Windows 98/XP/Vista
MS Office
Browser:-Internet
explorer/Netscape/MozillaFox
Which is your speciality:
Your Comments and Suggestions to improve software are most welcome.Thankyou for your time and support.
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You can now directly get DOCTOR2010 straight from here.
Just post a 'A/c Payee DD' for 'Rs 9,500'
' payable to
'Medisoft, A/c No 05/256, ICICI Bank, Cochin-35'. and
post it (Prefer-speedpost / Registered post) to
'MEDISOFT, Achutha Warrier Lane,M.G.Road, Cochin-682035'.
If so, only then fill in following details, software will be
be sent within 3 weeks of receiving order.
Ph: 09847294414.
Which software combination you need
Name of Bank
D.D./Cheque No
Dated
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