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toll free: 1-800-477-9103
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Custom Messaging Services
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**If you would like to make a general inquiry about our services, please use our Contact Form HERE.**

Professional Client Confidential Profile
Please make sure you fill out all required fields.

Discount Code
Name of Business / Practice :*
Owner / Manager:*
First Last
Office Address:*
Street Address City State ZIP Code
Is your office address the same as your billing address?:*
- YES
- NO
Billing Address:*
Street Address City State ZIP Code
Phone #:*
Is this the number you will be call forwarding to us?:*
- YES
- NO
What is the number you will be forwarding?:*
Private Office #:
Private Fax #:
Business Specialty: (briefly describe)*
Web Site (if applies):
Main email address:*
We prefer to email your invoice but if this is not convenient, please let us know:
Which email address?:*
What kind of Service Plan would you like to begin with? Low, Full, High, etc…
*Feel free to leave any questions you may have about our Service Plans in this box.
Do you need Voice Mail Screening?*
- YES
- NO
Answer Phrase: How do you want your Greeting (phone answered)?:*
- Good Morning/Afternoon....(Company Name)
- Thank you for calling
- Answering service for
- May I Help you?
- How may I help you?
- Answering Service, May I help you?
Do you want the Agent to say their name in the answer phrase?:*
- YES
- NO
Would you like your messages faxed or e-mailed to you daily, or would you prefer both?:*
- Faxed
- Emailed
- Both
What day would you like your messages sent to you?:*
*ie.) Mon - Fri, or Tues, Thurs, Fri
What time would you like your messages sent to you?:*
*Please specify if there are different times on different days, you would like to receive your messages.
Which e-mail address would you like them sent to?:
What are your Office Hours?:*
In addition to the CALLERS NAME & TEL #, what other information would you like us to get from the caller? ADDRESS, CITY, STATE, ZIP, CELL #, WORK #, IF EMERGENCY, REFERRED BY, PATIENT NAME, IF URGENT, BRIEF MESSAGE. Anything else:
- Callers Name
- Tel #
- Cell #
- Work #
- Address
- City
- State
- Zip
- Patient Name
- If Urgent
- Referred By
Please use this area to specify exactly, any other info you would like us to collect that wasn't listed above:
Dispatch Instructions:
How do you want your calls handled? Do you have an on call person? Do you have alternate on call people? ie.) Call in all emergencies, hold all office related calls:*
Should we:*
- page 1st
- call home 1st
- call cell 1st
- email 1st
Other dispatch instructions:
If unable to make contact with On-call person, what is alternative process/person to attempt contact?:
Emergency Calls:
What is considered an ‘E’ (Emergency) call?:*
What would be your prospective start date?:*
MM slash DD slash YYYY
Individual Professional On Call Information (please fill in as needed):
Person #1:
Name:
Title:
Home Phone:
Email:
Cell Phone:
Person #2:
Name:
Title:
Home Phone:
Email:
Cell Phone:
Person #3:
Name:
Title:
Home Phone:
Email:
Cell Phone:
Person #4:
Name:
Title:
Home Phone:
Email:
Cell Phone:
Person #5:
Name:
Title:
Home Phone:
Email:
Cell Phone:
Would you like to receive emails from us in the future?*
- Yes
- No
Email
This field is for validation purposes and should be left unchanged.

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1005 North Point Blvd, Suite 709, Baltimore, MD 21224 | phone: 410-288-7600 | toll free: 800-477-9103
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