Discovery Intake Form

Thank you for taking the time to provide us with this information! A HealthLevel team member will reach out to you shortly.

In the meantime, take a moment to learn more about Foundations™.

Help Us Understand Your Needs

Please take a few minutes to fill out the form below so we can best meet your needs for an integration into Foundations™. Not all fields are required and please give us your best estimate for numbers you are not sure of.

    Please Tell Us About Yourself

    Name

    Job Title

    Organization Name

    Email

    Phone



    Your Organization's Business Type(s)

    (Check all that apply.)
    Practice Teleradiology Practice Imaging Center Hospital Department
    Other


    Modalities Covered

    (Check all that apply.)
    CT MRI X-Ray PET Ultrasound
    Other


    Capacity

    (Numbers only please.)

    Annual Volume

    Annual Revenue

    Number of Locations



    Operational Needs

    Your Business Objectives
    (Please summarize a few key examples.)

    Your Primary Pain Points
    (Please summarize a few key examples.)

    Use Cases
    (Please summarize a few key examples.)



    Technology Systems

    PACS
    RIS
    Call Center
    EMR
    Ordering System
    Staffing System
    Business Intelligence System
    Billing/Finance/Claims System
    HL7 Feed
    DICOM Feed
    Other Feeds

    Staff Counts

    (Numbers only please.)

    Radiologists

    Schedulers

    Technologists

    IT

    Total Staff



    Additional Information

    (Please share anything else that we should be aware of.)

    Thank you for taking the time to provide us with this information! A HealthLevel team member will reach out to you shortly.

    In the meantime, take a moment to learn more about Foundations™.

    Foundations™ is the leading radiology business operations platform.

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