980 E. Foothill Blvd., Suite 103 Upland, CA 91786 Tel: (909) 985-8888 Fax: (909) 946-4168 if you are interested in finding out more about DOC2000, please fill out the form below for a free informational packet: Practice Information: * These fields are required for submission. E-mail Address:* Contact Name:* Name of Practice: Type of Practice:* Street Address 1:* Street Address 2: City:* State:* Zip Code:* Phone Number:* Fax Number: Current Operating System: Windows 98 Windows ME Windows 95 Windows NT DOS No Computer System Current Office Management System: What do you dislike about your current software? What are you looking for in a new office management system? How did you hear about our program?* Direct Mailing LACMA ad Current User Non-User Web directory Other What would you like from us? Informational Packet Yes No Free In-house Demonstration* Yes No *currently only offered to physicians in the LA, San Bernardino, Riverside and Orange Counties Questions: Thank you for your input