Step 3
Customer Information Entry
Your customers then enter minimal, nonobtrusive, information to eliminate data entry barriers. With fears of identity theft on everyone's mind, minimal information helps your customers feel more confident using the Healthe-Scheduler online scheduling system.
_________________________________________
Appointment Request for Your Name
Address
City, State Zip |
Your Logo goes here  |
APPOINTMENT: Date: 12/14/2005
Time: 01:00 - 01:30PM
______________________________________________
| Name of Person Setting Appt: |
John Smith |
* |
| Name of Customer, if different: |
|
|
Product/Service Wanted?
short descript 150 char limit |
Consultation, Legal |
* |
| Referred by? |
A friend who uses your services |
|
| Preferred time to call?: |
after 7pm |
|
| I give permission for an email to |
jsmith@myemail.net |
|
| I give permission for a call to Phone 1 |
111-111-1111 |
* |
| I gie permission for a call to Phone 2 |
|
|
| |
Request |
|
Entries marked with * are required
►Go to Step 4 |
