VOIP Service Application
For Healthcare Facilities
Facility Information
Facility Name
Facility Type
Hospital
Clinic
Diagnostic Lab
Other
Address
City
State/Region
Zip Code
Contact Person
Full Name
Position/Role
Phone Number
Email Address
Service Requirements
Estimated Number of Users
Current Telecom Provider
Required Features (Select all that apply)
Call Forwarding
Voicemail
Video Calling
Auto Attendant
Call Recording
Other
Additional Notes