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Thank you for your interest in AdvoCare.

Before you begin downloading the demo, please take a moment to fill out the following form. By doing so, we will be able to assist your specific requests for additional information. Also, note that AdvoCare Medical will never use your personal information for any reason beyond the information you are requesting, nor will AdvoCare Medical ever sell or distribute your personal information to others.

Would you like us to send you this Demo on CD-ROM? Yes        No
Name:
E-mail Address:
Practice Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Phone Number:
Fax Number:
   
Are you currently using an in-house computer system? Yes       No
If Yes, which system are you currently using?
What is your primary Operating System (OS) ? Windows VistaWindows 7
Windows 9x
Windows 2000
Windows XP Home
Windows XP Pro		 Unix
Linux
Mac
Other
How Many Physicians are there in your practice?
What is your practice Specialty?
When do you plan to purchase or upgrade your system?
Is there any additional information which may be helpful for us to know?