CLIN1 Web QC Registration
CLIN1 offers several QC/QA solutions for just about any environment and budget.
Contact Name
*
Full Name
Contact Title / Position
Contact E-mail
*
example@example.com
Contact Phone Number
*
Facility Name
*
Enter Company Name
Facility ID
Create a Facility ID
Facility Phone Number
*
Facility Fax Number
Facility Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Configuration Option
*
Please Select
Secure External Hosted Server
Installed on your Local Server
TBD - Discuss with CLIN1 Technical Support
Users Required
*
You can always add more users later
Select Payment Schedule
*
Please Select
Monthly (Pay month to month)
Annually (Pay once a Year w/ 5% Discount)
Select Facility Rule Set Option
*
Please Select
WESTGARD
WESTGARD6
WESTGARD8
WESTGARD9
NELSON
WECO
AIAG
MONTGOMERY
HEALTHCARE
Objective/Need/Additional Info:
Submit
Should be Empty:
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