Request for Pharmacy Information

Send us your request for information by using the form below.
An asterisk (*) denotes a required field.

Your Name*:
Your Title*:
Hospital/Clinic*:
Street Address 1*:
Street Address 2:
City*:
State or Province*:
Zip/Postal Code:
Country:
Phone*:	ext.
Fax Number:
E-mail*:
Your hospital size (beds) Under 100 100-200 200-300 300-400 400-500 Over 500
Number of Facilities 1 2 3 4 Over 4
What pharmacy system do you currently use and when was it first implemented?
What HIS System do you currently use?
In which pharmacy functionalities are you interested? (Check all that apply) Inpatient Outpatient HMO Hospice Other (please specify):
What is the desired pharmacy system project start date?
What is the likely overall budget range for this initiative?
In which budget year is the initiative likely to be included in?
Will there be an RFI process? Yes No Unsure
Will there be an RFP process? Yes No Unsure
At which stage in the process are you? Information gathering budgeting pre RFI pre RFP
What is your desired pharmacy system live date?
What is the anticipated number of end users on the system?
What is your current network environment?
What are the major priorities and challenges at your site?
How did you come about GE Medical Systems Information Technologies?
Do you have any specific questions you would like answered?