General Information

Company name:

Time zone:

Please select the days your office is open and available:
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Monday office hours:
to

Tuesday office hours:
to

Wednesday office hours:
to

Thursday office hours:
to

Friday office hours:
to

Saturday office hours:
to

Sunday office hours:
to

Address:

City:

State:

Zip:

Billing address:

City:

State:

Zip:

Office phone:

Office fax:

Website:

Contact person:

Private phone:

Email:

Accounts payable contact:

Phone:

Nature of business:

How would you like to receive your billing invoice?
FaxEmail

Enter billing fax:

Enter billing email:

Greetings and Voicemail

Do you want callers to have an option to leave a voicemail message before reaching an operator?
YesNo

Does your account require a recording/greeting that will play immediately before each incoming call?
YesNo

Please specify:

Would you like your
greeting to be recorded by one of our operators?
YesNo

Would you like your greeting recorded by a male or female?
MaleFemaleNo preference

How would you like the operators to answer your phone calls? (For example: Thank you for calling Alliance
Communications, this is John. How may I help you?)

Do you want a specific AWAY phrase (reason to give caller why you are unavailable)?
YesNo

Please specify:

Messages

Are you a medical company?
YesNo

Message form (check questions you would like to be asked):
ToFromArea code / phone #Company (if applicable)Street address / apt. # / suite #City / state / zipIs this an emergency?Best time to return call

Message form (check questions you would like to be asked):
ToFromArea code / phone #Regular doctorPatient name / ageIs this an emergency?Regarding message (tags and newborns are taken on preset form)

Please list any additional questions you would like to be asked:
1:
2:
3:
4:
5:

How would you like your non-emergency messages delivered to you? (Select all that apply)
FaxEmailVoicemailAlphanumeric pagingDigital pagingText messageN/A

Fax number:

Email address:

Do you use Time Communications voicemail or internal voicemail?
Time CommunicationsInternal

Voicemail number:

Alphanumeric paging company:

Alphanumeric pager number:

Alphanumeric paging tower / modem number to relay messages:

Alphanumeric paging PIN number:

Digital pager number:

Text message cell phone number:

Text message cell phone carrier:

How would you like your emergency messages delivered to you? (Select all that apply)
FaxEmailVoicemailAlphanumeric pagingDigital pagingText messageSame as non-emergency messagesOtherN/A

Fax number:

Email address:

Do you use Time Communications voicemail or internal voicemail?
Time CommunicationsInternal

Voicemail number:

Alphanumeric paging company:

Alphanumeric pager number:

Alphanumeric paging tower / modem number to relay messages:

Alphanumeric paging PIN number:

Digital pager number:

Text message cell phone number:

Text message cell phone carrier:

Other – please specify:

Would you like faxed and emailed messages to be delivered as soon as the call is finished or sent in a recap at a scheduled time?
As soon as call is finishedSent in a recap at a scheduled time

Please indicate days to receive a recap:
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Monday recap time:

Tuesday recap time:

Wednesday recap time:

Thursday recap time:

Friday recap time:

Saturday recap time:

Sunday recap time:

How do you want non-emergency calls to be handled?

What procedures should we use for dispatching your emergency calls? Each subsequent step will be taken if the previous one fails. List all steps below:

1:

Name:

Phone number:

Should we leave a message if this person doesn’t answer?
YesNo

Please specify:

How long should our operators wait for a response before moving on to the next step?

Should we repeat from step one until delivered if the operator gets to the last step without successfully dispatching the message?
YesNo

Additional Information

Please list up to 7 on-call staff in preferred call order:

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Full name:

Home phone (if applicable)

Cell phone (if applicable)

Office phone (if applicable)

Do you have call forwarding on your office lines?
YesNo

Do you have busy / no answer on your office lines?
YesNo

Choose the holidays you need service for:
New Year's DayEasterLabor DayMemorial DayIndependence DayThanksgivingChristmas

May we accept long-distance collect calls?
YesNo

Do you have on-call personnel that rotate daily, weekly, or monthly?
YesNo

Additional comments / instructions:

To do: upload files

1-800-555-3738