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AUI Tab Group
truetabBusinessInformationBusiness InformationBusinessInformationFormtrueBusiness Information

ClientNameClient Name:'Client Name' is a required fieldtexttrue ClientName:[entry.ClientName] AND !id:[entry.id]Client Name is already existing !Validation rule datasetClientName

DateFilledDate:'Date' is a required fielddatetrue

SiteAddressSite Address'Site Address' is a required fieldtexttrue

SiteCityStateCity / State'City / State' is a required fieldtexttrue

TaxIDTax ID#:'Tax ID#' is a required fieldtexttrue

BusinessHoursOfOperationBusiness Hours of Operation:'Business Hours of Operation' is a required fieldtexttrue

LunchPeriodBeginsLunch Period Begins:text 

LunchPeriodToLunch Period Ends:text

PreferredPaymentMethodPreferred Payment Method'Preferred Payment Method' is a required fieldfalse[1=Check|2=Credit Card (3% Fee)|3=ACH (Bank Draft)|]onlabel;falseradio_grouptrue

ClientIPClient IP:false[1=Check|2=Credit Card|3=ACH (Bank Draft)|]onip







Run JavaScriptonCreatedtruetrueSend EmailonCreated[entry.ClientName] Office Information Questionnaireaccounting@dhsforyou.com,reports@dhsforyou.com
Business InformationIP: [entry.ClientIP]
Client Name[entry.ClientName]
Date[entry.DateFilled.formatDate(MMM dd, yyyy)]
Site Address[entry.SiteAddress]
City / State[entry.SiteCityState]
TaxID#[entry.TaxID]
BusinessHoursOfOperation[entry.BusinessHoursOfOperation]
LunchPeriodBegins[entry.LunchPeriodBegins]
LunchPeriodTo[entry.LunchPeriodTo]
PreferredPaymentMethod[entry.PreferredPaymentMethod.label]
SubmitBusinessInformationFormtrueINLINEtrue15%

Date:

35%

width:90%;DateFilled

15%

Client Name:

35%

width:100%;ClientName

true15%

Site Address

35%

width:90%;SiteAddress

15%

City / State:

35%

width:100%;SiteCityState

true15%

Tax ID#:

35%

width:100%;TaxID

15%

Business Hours of Operation:

35%

width:100%;BusinessHoursOfOperation

true15%

Lunch Period From:

35%

12:00 PMwidth:100%;max-width:100%;LunchPeriodBegins

15%

Lunch Period To:

35%

01:00 PMwidth:100%;max-width:100%;LunchPeriodTo

true15%

Preferred Payment Method:

35%

width:100%PreferredPaymentMethod

15%


35%


tabAdministrativeAdministrative Contact InformationAdministrativeFormAdministrative Contact Information

ClientIPClient IP:false[1=Check|2=Credit Card|3=ACH (Bank Draft)|]onip

Primary Business Contact1

FirstLastNamePBC1First / Last Nametext

TitlePBC1Title / Positiontext

CellPhonePBC1Cell Phone #text

HomePhonePBC1Home Phone #text

OfficePhoneOrExtensionPBC1Office Phone # or Extensiontext

OfficePersonalEmailPBC1Office / Personal Emailtext

Primary Business Contact2

FirstLastNamePBC2First / Last Nametext

TitlePBC2Title / Positiontext

CellPhonePBC2Cell Phone #text

HomePhonePBC2Home Phone #text

OfficePhoneOrExtensionPBC2Office Phone # or Extensiontext

OfficePersonalEmailPBC2Office / Personal Emailtext

Primary Business Contact3

FirstLastNamePBC3First / Last Nametext

TitlePBC3Title / Positiontext

CellPhonePBC3Cell Phone #text

HomePhonePBC3Home Phone #text

OfficePhoneOrExtensionPBC3Office Phone # or Extensiontext

OfficePersonalEmailPBC3Office / Personal Emailtext

Primary Business Contact4

FirstLastNamePBC4First / Last Nametext

TitlePBC4Title / Positiontext

CellPhonePBC4Cell Phone #text

HomePhonePBC4Home Phone #text

OfficePhoneOrExtensionPBC4Office Phone # or Extensiontext

OfficePersonalEmailPBC4Office / Personal Emailtext

Primary Business Contact5

FirstLastNamePBC5First / Last Nametext

TitlePBC5Title / Positiontext

CellPhonePBC5Cell Phone #text

HomePhonePBC5Home Phone #text

OfficePhoneOrExtensionPBC5Office Phone # or Extensiontext

OfficePersonalEmailPBC5Office / Personal Emailtext

Primary Business Contact6

FirstLastNamePBC6First / Last Nametext

TitlePBC6Title / Positiontext

CellPhonePBC6Cell Phone #text

HomePhonePBC6Home Phone #text

OfficePhoneOrExtensionPBC6Office Phone # or Extensiontext

OfficePersonalEmailPBC6Office / Personal Emailtext

Primary Business Contact7

FirstLastNamePBC7First / Last Nametext

TitlePBC7Title / Positiontext

CellPhonePBC7Cell Phone #text

HomePhonePBC7Home Phone #text

OfficePhoneOrExtensionPBC7Office Phone # or Extensiontext

OfficePersonalEmailPBC7Office / Personal Emailtext

Primary Business Contact8

FirstLastNamePBC8First / Last Nametext

TitlePBC8Title / Positiontext

CellPhonePBC8Cell Phone #text

HomePhonePBC8Home Phone #text

OfficePhoneOrExtensionPBC8Office Phone # or Extensiontext

OfficePersonalEmailPBC8Office / Personal Emailtext

Primary Business Contact9

FirstLastNamePBC9First / Last Nametext

TitlePBC9Title / Positiontext

CellPhonePBC9Cell Phone #text

HomePhonePBC9Home Phone #text

OfficePhoneOrExtensionPBC9Office Phone # or Extensiontext

OfficePersonalEmailPBC9Office / Personal Emailtext


Office Manager

FirstLastNameOMFirst / Last Nametext

TitleOMTitle / Positiontext

CellPhoneOMCell Phone #text

OfficePhoneOrExtensionOMOffice Phone # or Extensiontext

OfficePersonalEmailOMOffice / Personal Emailtext

Internal Technical Contact

FirstLastNameITCFirst / Last Nametext

TitleTCTitle / Positiontext

CellPhoneITCCell Phone #text

OfficePhoneOrExtensionTCOffice Phone # or Extensiontext

OfficePersonalEmailITCOffice / Personal Emailtext


Internal Billing Contact

FirstLastNameIBCFirst / Last Nametext

TitleBCTitle / Positiontext

CellPhoneIBCCell Phone #text

OfficePhoneOrExtensionBCOffice Phone # or Extensiontext

OfficePersonalEmailIBCOffice / Personal Emailtext


Run JavaScriptonCreatedtruetrueSend EmailonCreated[entry.ClientIP] Administrative Contact Informationaccounting@dhsforyou.com,reports@dhsforyou.com
Administrative Contact InformationIP: [entry.ClientIP]

First / Last NameTitle / PositionCell Phone #Home Phone #Office Phone # or ExtensionOffice / Personal Email
Owner/Executive #1[entry.FirstLastNamePBC1][entry.TitlePBC1][entry.CellPhonePBC1][entry.HomePhonePBC1][entry.OfficePhoneOrExtensionPBC1][entry.OfficePersonalEmailPBC1]
Owner/Executive #2[entry.FirstLastNamePBC2][entry.TitlePBC2][entry.CellPhonePBC2][entry.HomePhonePBC2][entry.OfficePhoneOrExtensionPBC2][entry.OfficePersonalEmailPBC2]
Owner/Executive #3[entry.FirstLastNamePBC3][entry.TitlePBC3][entry.CellPhonePBC3][entry.HomePhonePBC3][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Owner/Executive #4[entry.FirstLastNamePBC4][entry.TitlePBC4][entry.CellPhonePBC4][entry.HomePhonePBC4][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Owner/Executive #5[entry.FirstLastNamePBC5][entry.TitlePBC5][entry.CellPhonePBC5][entry.HomePhonePBC5][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Owner/Executive #6[entry.FirstLastNamePBC6][entry.TitlePBC6][entry.CellPhonePBC6][entry.HomePhonePBC6][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Owner/Executive #7[entry.FirstLastNamePBC7][entry.TitlePBC7][entry.CellPhonePBC7][entry.HomePhonePBC7][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Owner/Executive #8[entry.FirstLastNamePBC8][entry.TitlePBC8][entry.CellPhonePBC8][entry.HomePhonePBC8][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Owner/Executive #9[entry.FirstLastNamePBC9][entry.TitlePBC9][entry.CellPhonePBC9][entry.HomePhonePBC9][entry.OfficePhoneOrExtensionPBC3][entry.OfficePersonalEmailPBC3]
Office Manager[entry.FirstLastNameOM][entry.TitleOM][entry.CellPhoneOM]
[entry.OfficePhoneOrExtensionOM][entry.OfficePersonalEmailOM]
Internal Technical Contact[entry.FirstLastNameITC][entry.TitleTC][entry.CellPhoneITC]
[entry.OfficePhoneOrExtensionTC][entry.OfficePersonalEmailITC]
Internal Billing Contact[entry.FirstLastNameIBC][entry.TitleBC][entry.CellPhoneIBC]
[entry.OfficePhoneOrExtensionBC][entry.OfficePersonalEmailIBC]
SubmitAdministrativeFormtrueINLINE
Owner/Executive Owner/Executive Owner/Executive

FirstLastNamePBC1true

TitlePBC1true

CellPhonePBC1true

HomePhonePBC1true

OfficePhoneOrExtensionPBC1true

OfficePersonalEmailPBC1true

FirstLastNamePBC2true

TitlePBC2true

CellPhonePBC2true

HomePhonePBC2true

OfficePhoneOrExtensionPBC2true

OfficePersonalEmailPBC2true

FirstLastNamePBC3true

TitlePBC3true

CellPhonePBC3true

HomePhonePBC3true

OfficePhoneOrExtensionPBC3true

OfficePersonalEmailPBC3true

Owner/Executive Owner/Executive Owner/Executive

FirstLastNamePBC4true

TitlePBC4true

CellPhonePBC4true

HomePhonePBC4true

OfficePhoneOrExtensionPBC4true

OfficePersonalEmailPBC4true

FirstLastNamePBC5true

TitlePBC5true

CellPhonePBC5true

HomePhonePBC5true

OfficePhoneOrExtensionPBC5true

OfficePersonalEmailPBC5true

FirstLastNamePBC6true

TitlePBC6true

CellPhonePBC6true

HomePhonePBC6true

OfficePhoneOrExtensionPBC6true

OfficePersonalEmailPBC6true

Owner/Executive Owner/Executive Owner/Executive

FirstLastNamePBC7true

TitlePBC7true

CellPhonePBC7true

HomePhonePBC7true

OfficePhoneOrExtensionPBC7true

OfficePersonalEmailPBC7true

FirstLastNamePBC8true

TitlePBC8true

CellPhonePBC8true

HomePhonePBC8true

OfficePhoneOrExtensionPBC8true

OfficePersonalEmailPBC8true

FirstLastNamePBC9true

TitlePBC9true

CellPhonePBC9true

HomePhonePBC9true

OfficePhoneOrExtensionPBC9true

OfficePersonalEmailPBC9true

Office Manager Internal Technical Contact Internal Billing Contact

FirstLastNameOMtrue

TitleOMtrue

CellPhoneOMtrue

OfficePhoneOrExtensionOMtrue

OfficePersonalEmailOMtrue

FirstLastNameITCtrue

TitleTCtrue

CellPhoneITCtrue

OfficePhoneOrExtensionTCtrue

OfficePersonalEmailITCtrue


FirstLastNameIBCtrue

TitleBCtrue

CellPhoneIBCtrue

OfficePhoneOrExtensionBCtrue

OfficePersonalEmailIBCtrue


tabStaffMemberStaff Member Contact InformationStaffMemberContactFormStaff Member Contact Information

ClientIPClient IP:false[1=Check|2=Credit Card|3=ACH (Bank Draft)|]onip

Staff Member Contact

FirstLastNameSMC1First / Last Nametext

TitlePositionSMC1Title / Position text

OfficePhoneOrExtensionSMC1Office Phone # or Extensiontext

OfficePersonalEmailSMC1Office / Personal Emailtext

Staff Member Contact

FirstLastNameSMC2First / Last Nametext

TitlePositionSMC2Title / Position text

OfficePhoneOrExtensionSMC2Office Phone # or Extensiontext

OfficePersonalEmailSMC2Office / Personal Emailtext

Staff Member Contact

FirstLastNameSMC3First / Last Name :text

TitlePositionSMC3Title / Position :text

OfficePhoneOrExtensionSMC3Office Phone # or Extension :text

OfficePersonalEmailSMC3Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC4First / Last Name :text

TitlePositionSMC4Title / Position :text

OfficePhoneOrExtensionSMC4Office Phone # or Extension :text

OfficePersonalEmailSMC4Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC5First / Last Name :text

TitlePositionSMC5Title / Position :text

OfficePhoneOrExtensionSMC5Office Phone # or Extension :text

OfficePersonalEmailSMC5Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC6First / Last Name :text

TitlePositionSMC6Title / Position :text

OfficePhoneOrExtensionSMC6Office Phone # or Extension :text

OfficePersonalEmailSMC6Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC7First / Last Name :text

TitlePositionSMC7Title / Position :text

OfficePhoneOrExtensionSMC7Office Phone # or Extension :text

OfficePersonalEmailSMC7Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC8First / Last Name :text

TitlePositionSMC8Title / Position :text

OfficePhoneOrExtensionSMC8Office Phone # or Extension :text

OfficePersonalEmailSMC8Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC9First / Last Name :text

TitlePositionSMC9Title / Position :text

OfficePhoneOrExtensionSMC9Office Phone # or Extension :text

OfficePersonalEmailSMC9Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC10First / Last Name :text

TitlePositionSMC10Title / Position :text

OfficePhoneOrExtensionSMC10Office Phone # or Extension :text

OfficePersonalEmailSMC10Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC11First / Last Name :text

TitlePositionSMC11Title / Position :text

OfficePhoneOrExtensionSMC11Office Phone # or Extension :text

OfficePersonalEmailSM11Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC12First / Last Name :text

TitlePositionSMC12Title / Position :text

OfficePhoneOrExtensionSMC12Office Phone # or Extension :text

OfficePersonalEmailSMC12Office / Personal Email :text

Staff Member Contact

FirstLastNameSM13First / Last Name :text

TitlePositionSMC13Title / Position :text

OfficePhoneOrExtensionSMC13Office Phone # or Extension :text

OfficePersonalEmailSMC13Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC14First / Last Name :text

TitlePositionSMC14Title / Position :text

OfficePhoneOrExtensionSMC14Office Phone # or Extension :text

OfficePersonalEmailSMC14Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC15First / Last Name :text

TitlePositionSMC15Title / Position :text

OfficePhoneOrExtensionSMC15Office Phone # or Extension :text

OfficePersonalEmailSMC15Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC16First / Last Name :text

TitlePositionSMC16Title / Position :text

OfficePhoneOrExtensionSMC16Office Phone # or Extension :text

OfficePersonalEmailSMC16Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC17First / Last Name :text

TitlePositionSMC17Title / Position :text

OfficePhoneOrExtensionSMC17Office Phone # or Extension :text

OfficePersonalEmailSMC17Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC18First / Last Name :text

TitlePositionSMC18Title / Position :text

OfficePhoneOrExtensionSMC18Office Phone # or Extension :text

OfficePersonalEmailSMC18Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC19First / Last Name :text

TitlePositionSMC19Title / Position :text

OfficePhoneOrExtensionSMC19Office Phone # or Extension :text

OfficePersonalEmailSMC19Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC20First / Last Name :text

TitlePositionSMC20Title / Position :text

OfficePhoneOrExtensionSMC20Office Phone # or Extension :text

OfficePersonalEmailSMC20Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC21First / Last Name :text

TitlePositionSMC21Title / Position :text

OfficePhoneOrExtensionSMC21Office Phone # or Extension :text

OfficePersonalEmailSMC21Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC22First / Last Name :text

TitlePositionSMC22Title / Position :text

OfficePhoneOrExtensionSMC22Office Phone # or Extension :text

OfficePersonalEmailSMC22Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC23First / Last Name :text

TitlePositionSMC23Title / Position :text

OfficePhoneOrExtensionSMC23Office Phone # or Extension :text

OfficePersonalEmailSMC23Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC24First / Last Name :text

TitlePositionSMC24Title / Position :text

OfficePhoneOrExtensionSMC24Office Phone # or Extension :text

OfficePersonalEmailSMC24Office / Personal Email :text

Staff Member Contact

FirstLastNameSMC25First / Last Name :text

TitlePositionSMC25Title / Position :text

OfficePhoneOrExtensionSMC25Office Phone # or Extension :text

OfficePersonalEmailSMC25Office / Personal Email :text

AttachFileAttachmentfile


Run JavaScriptonCreatedtruetrueSend EmailonCreated[entry.ClientIP] Staff Member Contact Informationaccounting@dhsforyou.com,reports@dhsforyou.com
Staff Member Contact InformationIP: [entry.ClientIP]
#First / Last NameTitle / PositionOffice Phone # or ExtensionOffice / Personal Email
1[entry.FirstLastNameSMC1][entry.TitlePositionSMC1][entry.OfficePhoneOrExtensionSMC1][entry.OfficePersonalEmailSMC1]
2[entry.FirstLastNameSMC2][entry.TitlePositionSMC2][entry.OfficePhoneOrExtensionSMC2][entry.OfficePersonalEmailSMC2]
3[entry.FirstLastNameSMC3][entry.TitlePositionSMC3][entry.OfficePhoneOrExtensionSMC3][entry.OfficePersonalEmailSMC3]
4[entry.FirstLastNameSMC4][entry.TitlePositionSMC4][entry.OfficePhoneOrExtensionSMC4][entry.OfficePersonalEmailSMC4]
5[entry.FirstLastNameSMC5][entry.TitlePositionSMC5][entry.OfficePhoneOrExtensionSMC5][entry.OfficePersonalEmailSMC5]
6[entry.FirstLastNameSMC6][entry.TitlePositionSMC6][entry.OfficePhoneOrExtensionSMC6][entry.OfficePersonalEmailSMC6]
7[entry.FirstLastNameSMC7][entry.TitlePositionSMC7][entry.OfficePhoneOrExtensionSMC7][entry.OfficePersonalEmailSMC7]
8[entry.FirstLastNameSMC8][entry.TitlePositionSMC8][entry.OfficePhoneOrExtensionSMC8][entry.OfficePersonalEmailSMC8]
9[entry.FirstLastNameSMC9][entry.TitlePositionSMC9][entry.OfficePhoneOrExtensionSMC9][entry.OfficePersonalEmailSMC9]
10[entry.FirstLastNameSMC10][entry.TitlePositionSMC10][entry.OfficePhoneOrExtensionSMC10][entry.OfficePersonalEmailSMC10]
11[entry.FirstLastNameSMC11][entry.TitlePositionSMC11][entry.OfficePhoneOrExtensionSMC11][entry.OfficePersonalEmailSMC11]
12[entry.FirstLastNameSMC12][entry.TitlePositionSMC12][entry.OfficePhoneOrExtensionSMC12][entry.OfficePersonalEmailSMC12]
13[entry.FirstLastNameSMC13][entry.TitlePositionSMC13][entry.OfficePhoneOrExtensionSMC13][entry.OfficePersonalEmailSMC13]
14[entry.FirstLastNameSMC14][entry.TitlePositionSMC14][entry.OfficePhoneOrExtensionSMC14][entry.OfficePersonalEmailSMC14]
15[entry.FirstLastNameSMC15][entry.TitlePositionSMC15][entry.OfficePhoneOrExtensionSMC15][entry.OfficePersonalEmailSMC15]
16[entry.FirstLastNameSMC16][entry.TitlePositionSMC16][entry.OfficePhoneOrExtensionSMC16][entry.OfficePersonalEmailSMC16]
17[entry.FirstLastNameSMC17][entry.TitlePositionSMC17][entry.OfficePhoneOrExtensionSMC17][entry.OfficePersonalEmailSMC17]
18[entry.FirstLastNameSMC18][entry.TitlePositionSMC18][entry.OfficePhoneOrExtensionSMC18][entry.OfficePersonalEmailSMC18]
19[entry.FirstLastNameSMC19][entry.TitlePositionSMC19][entry.OfficePhoneOrExtensionSMC19][entry.OfficePersonalEmailSMC19]
20[entry.FirstLastNameSMC20][entry.TitlePositionSMC20][entry.OfficePhoneOrExtensionSMC20][entry.OfficePersonalEmailSMC20]
21[entry.FirstLastNameSMC21][entry.TitlePositionSMC21][entry.OfficePhoneOrExtensionSMC21][entry.OfficePersonalEmailSMC21]
22[entry.FirstLastNameSMC22][entry.TitlePositionSMC22][entry.OfficePhoneOrExtensionSMC22][entry.OfficePersonalEmailSMC22]
23[entry.FirstLastNameSMC23][entry.TitlePositionSMC23][entry.OfficePhoneOrExtensionSMC23][entry.OfficePersonalEmailSMC23]
24[entry.FirstLastNameSMC24][entry.TitlePositionSMC24][entry.OfficePhoneOrExtensionSMC24][entry.OfficePersonalEmailSMC24]
25[entry.FirstLastNameSMC25][entry.TitlePositionSMC25][entry.OfficePhoneOrExtensionSMC25][entry.OfficePersonalEmailSMC25]

Please see the attached Floor Plan document below

AttachFiletrue

SubmitStaffMemberContactFormtrueINLINE

Alternatively, you may attach a Microsoft Excel spreadsheet containing data points below by clicking the "Browse" button on the bottom of this form.

1
1

FirstLastNameSMC1

TitlePositionSMC1

OfficePhoneOrExtensionSMC1

OfficePersonalEmailSMC1

2

FirstLastNameSMC2

TitlePositionSMC2

OfficePhoneOrExtensionSMC2

OfficePersonalEmailSMC2

3

FirstLastNameSMC3

TitlePositionSMC3

OfficePhoneOrExtensionSMC3

OfficePersonalEmailSMC3

4

FirstLastNameSMC4

TitlePositionSMC4

OfficePhoneOrExtensionSMC4

OfficePersonalEmailSMC4

5

FirstLastNameSMC5

TitlePositionSMC5

OfficePhoneOrExtensionSMC5

OfficePersonalEmailSMC5

6

FirstLastNameSMC6

TitlePositionSMC6

OfficePhoneOrExtensionSMC6

OfficePersonalEmailSMC6

7

FirstLastNameSMC7

TitlePositionSMC7

OfficePhoneOrExtensionSMC7

OfficePersonalEmailSMC7

8

FirstLastNameSMC8

TitlePositionSMC8

OfficePhoneOrExtensionSMC8

OfficePersonalEmailSMC8

9

FirstLastNameSMC9

TitlePositionSMC9

OfficePhoneOrExtensionSMC9

OfficePersonalEmailSMC9

10

FirstLastNameSMC10

TitlePositionSMC10

OfficePhoneOrExtensionSMC10

OfficePersonalEmailSMC10

11

FirstLastNameSMC11

TitlePositionSMC11

OfficePhoneOrExtensionSMC11

OfficePersonalEmailSMC11

12

FirstLastNameSMC12

TitlePositionSMC12

OfficePhoneOrExtensionSMC12

OfficePersonalEmailSMC12

13

FirstLastNameSMC13

TitlePositionSMC13

OfficePhoneOrExtensionSMC13

OfficePersonalEmailSMC13

14

FirstLastNameSMC14

TitlePositionSMC14

OfficePhoneOrExtensionSMC14

OfficePersonalEmailSMC14

15

FirstLastNameSMC15

TitlePositionSMC15

OfficePhoneOrExtensionSMC15

OfficePersonalEmailSMC15

16

FirstLastNameSMC16

TitlePositionSMC16

OfficePhoneOrExtensionSMC16

OfficePersonalEmailSMC16

17

FirstLastNameSMC17

TitlePositionSMC17

OfficePhoneOrExtensionSMC17

OfficePersonalEmailSMC17

18

FirstLastNameSMC18

TitlePositionSMC18

OfficePhoneOrExtensionSMC18

OfficePersonalEmailSMC18

19

FirstLastNameSMC19

TitlePositionSMC19

OfficePhoneOrExtensionSMC19

OfficePersonalEmailSMC19

20

FirstLastNameSMC20

TitlePositionSMC20

OfficePhoneOrExtensionSMC20

OfficePersonalEmailSMC20

21

FirstLastNameSMC21

TitlePositionSMC21

OfficePhoneOrExtensionSMC21

OfficePersonalEmailSMC21

22

FirstLastNameSMC22

TitlePositionSMC22

OfficePhoneOrExtensionSMC22

OfficePersonalEmailSMC22

23

FirstLastNameSMC23

TitlePositionSMC23

OfficePhoneOrExtensionSMC23

OfficePersonalEmailSMC23

24

FirstLastNameSMC24

TitlePositionSMC24

OfficePhoneOrExtensionSMC24

OfficePersonalEmailSMC24

25

FirstLastNameSMC25

TitlePositionSMC25

OfficePhoneOrExtensionSMC25

OfficePersonalEmailSMC25

Please click the "Choose Files" button below, select your spreadsheet document, and click "Submit".

AttachFiletrue

tabEmailAccountEmail Account InformationEmailAccountFormEmail Account Information


ClientIPClient IP:false[1=Check|2=Credit Card|3=ACH (Bank Draft)|]onip

FirstLastNameACUser1User #1 First/Last Name :text

EmailACUser1User #1 Email:text

Password1User #1 Password :text

FirstLastNameACUser2User #2 First/Last Name :text

EmailACUser2User #2 Email:text

Password2User #2 Password :text

FirstLastNameACUser3User #3 First/Last Name :text

EmailACUser3User #3 Email:text

Password3User #3 Password :text

FirstLastNameACUser4User #4 First/Last Name :text

EmailACUser4User #4 Email:text

Password4User #4 Password :text

FirstLastNameACUser5User #5 First/Last Name :text

EmailACUser5User #5 Email:text

Password5User #5 Password :text

FirstLastNameACUser6User #6 First/Last Name :text

EmailACUser6User #6 Email:text

Password6User #6 Password :text

FirstLastNameACUser7User #7 First/Last Name :text

EmailACUser7User #7 Email:text

Password7User #7 Password :text

FirstLastNameACUser8User #8 First/Last Name :text

EmailACUser8User #8 Email:text

Password8User #8 Password :text

FirstLastNameACUser9User #9 First/Last Name :text

EmailACUser9User #9 Email:text

Password9User #9 Password :text

Run JavaScriptonCreatedtruetrueSend EmailonCreated[entry.ClientIP] Email Account Informationaccounting@dhsforyou.com,reports@dhsforyou.com
Email Account InformationIP: [entry.ClientIP]
#Account User First / Last Name or Group NameEmail AddressPassword
1[entry.FirstLastNameACUser1][entry.EmailACUser1][entry.Password1]
2[entry.FirstLastNameACUser2][entry.EmailACUser2][entry.Password2]
3[entry.FirstLastNameACUser3][entry.EmailACUser3][entry.Password3]
4[entry.FirstLastNameACUser4][entry.EmailACUser4][entry.Password4]
5[entry.FirstLastNameACUser5][entry.EmailACUser5][entry.Password5]
6[entry.FirstLastNameACUser6][entry.EmailACUser6][entry.Password6]
7[entry.FirstLastNameACUser7][entry.EmailACUser7][entry.Password7]
8[entry.FirstLastNameACUser8][entry.EmailACUser8][entry.Password8]
9[entry.FirstLastNameACUser9][entry.EmailACUser9][entry.Password9]
SubmitEmailAccountFormtrueINLINE

We will need access to all current 3rd party web-based email accounts (gmail, yahoo, etc) used internally by staff in order to migrate them to the new email system. Note that this form does not need to be completed if all company email addresses reflect your website domain (e.g. John@FamilyMedical.com).

Account User First & Last Name or Group Name
Email Address
Password
1

FirstLastNameACUser1

EmailACUser1

Password1

2

FirstLastNameACUser2

EmailACUser2

Password2

3

FirstLastNameACUser3

EmailACUser3

Password3

4

FirstLastNameACUser4

EmailACUser4

Password4

5

FirstLastNameACUser5

EmailACUser5

Password5

6

FirstLastNameACUser6

EmailACUser6

Password6

7

FirstLastNameACUser7

EmailACUser7

Password7

8

FirstLastNameACUser8

EmailACUser8

Password8

9

FirstLastNameACUser9

EmailACUser9

Password9

OthersOther InformationOthersFormtrueOther Information


ClientIPClient IP:false[1=Check|2=Credit Card|3=ACH (Bank Draft)|]onip

AlarmDisarmingProcedureAlarm Disarming Proceduretext

AlarmArmingProcedureAlarm Arming Proceduretext

AlarmBuildingEntranceExitPathAlarm Building Entrance / Exit Pathtext

AlarmBuildingLocationAlarm Building Locationtext

AlarmCompanySupportHotlineAlarm Company Support Hotlinetext

AlarmDisarmCallInVerificationPasswordAlarm Disarm Call In Verification Passwordtext


TrashRecyclingContainerLocationOutdoor trash/recycling container locationtext

TrashRecyclineEverLockedAre trash/recycling containers ever locked?false[1=Yes|2=No|]trueradio_group

TrashRecyclineContainerLockKeyLocationTrash/recycling container lock key locationtext

LadderAvailableLadder Available?false[1=Yes|2=No|]trueradio_group

LadderApproximateHeightApproximate Heighttext

LadderLocationInOfficeLocation in Officetext


UnderFloorCrawlspaceAccessUnder Floor Crawl Space Access Location:text

AtticAccessAttic Access Door Location :text

FirstLastName01First / Last Name :text

FirstLastName02First / Last Name :text

FirstLastName03First / Last Name :text

FirstLastName04First / Last Name :text

FirstLastName05First / Last Name :text

FirstLastName06First / Last Name :text

FirstLastName07First / Last Name :text

FirstLastName08First / Last Name :text

FirstLastName09First / Last Name :text

FirstLastName10First / Last Name :text

SoftwareTitleVendorNameSoftware Title / Vendor Name:text

AccountNumberAccount Number :text

AccountPasswordAdministrator Account Username / Password:text








SubmitOthersFormtrueINLINE

Alarm Info:

In order to assist you in case of emergency and to perform technical services after hours when required, we require alarm disarming/arming ability. We have this arrangement with all of our clients.

true15%

35%

AlarmDisarmingProcedure

15%

35%

AlarmArmingProcedure

true15%

35%

AlarmBuildingEntranceExitPath

15%

35%

AlarmBuildingLocation



true15%

35%

AlarmCompanySupportHotline

15%

35%

AlarmDisarmCallInVerificationPassword

Trash/Recycling:

true15%

35%

TrashRecyclingContainerLocation

15%

35%

TrashRecyclineContainerLockKeyLocation

true15%

35%

TrashRecyclineEverLocked

15%


35%


Ladder Availability:

true15%

35%

LadderAvailable

15%


35%


true15%

35%

LadderApproximateHeight

15%

35%

LadderLocationInOffice

Building Access: (for low voltage cabling)

true15%

35%

Under Floor Crawl Space Access Location:UnderFloorCrawlspaceAccess

15%

35%

Attic Access Door Location:AtticAccess

Staff Members who Need Remote Access to Office Computers:

true15%

35%

First / Last Name :FirstLastName01

15%

35%

First / Last Name :FirstLastName02

true15%

35%

First / Last Name :FirstLastName03

15%

35%

First / Last Name :FirstLastName04

true15%

35%

First / Last Name :FirstLastName05

15%

35%

First / Last Name :FirstLastName06

true15%

35%

First / Last Name :FirstLastName07

15%

35%

First / Last Name :FirstLastName08

true15%

35%

First / Last Name :FirstLastName09

15%

35%

First / Last Name :FirstLastName10

Practice Management Software Information:

true15%

35%

Software Title / Vendor Name:SoftwareTitleVendorName

15%


35%


true15%

35%

Account Number :AccountNumber

15%


35%


true15%

35%

Administrator Account Username / Password:AccountPassword

15%


35%






Delete ConfiForms EntryonDeletedClientName:[entry.id]AdministrativeForm:this


Delete ConfiForms EntryonDeletedClientName:[entry.id]StaffMemberContactForm:this


Delete ConfiForms EntryonDeletedClientName:[entry.id]EmailAccountForm:this


Delete ConfiForms EntryonDeletedClientName:[entry.id]BusinessInformationForm:this
Run JavaScriptonCreatedtruetrueSend EmailonCreated[entry.ClientIP] Other Informationaccounting@dhsforyou.com,reports@dhsforyou.com
Alarm InformationIP: [entry.ClientIP]
Alarm Disarming Procedure[entry.AlarmDisarmingProcedure]
Alarm Arming Procedure[entry.AlarmArmingProcedure]
Alarm Building Entrance / Exit Path[entry.AlarmBuildingEntranceExitPath]
Alarm Building Location[entry.AlarmBuildingLocation]
Alarm Company Support Hotline[entry.AlarmCompanySupportHotline]
Alarm Disarm Call In Verification Password[entry.AlarmDisarmCallInVerificationPassword]
Trash/Recycling
Outdoor trash/recycling container location[entry.TrashRecyclingContainerLocation]
Are trash/recycling containers ever locked?[entry.TrashRecyclineEverLocked.label]
Trash/recycling container lock key location[entry.TrashRecyclineContainerLockKeyLocation]
Ladder Availability
Ladder Available?[entry.LadderAvailable.label]
Approximate Height[entry.LadderApproximateHeight]
Location in Office[entry.LadderLocationInOffice]
Building Access: (for low voltage cabling)
Under Floor Crawl Space Access Location[entry.UnderFloorCrawlspaceAccess]
Attic Access Door Location[entry.AtticAccess]
Staff Members who Need Remote Access to Office Computers
First / Last Name[entry.FirstLastName01]
First / Last Name[entry.FirstLastName02]
First / Last Name[entry.FirstLastName03]
First / Last Name[entry.FirstLastName04]
First / Last Name[entry.FirstLastName05]
First / Last Name[entry.FirstLastName06]
First / Last Name[entry.FirstLastName07]
First / Last Name[entry.FirstLastName08]
First / Last Name[entry.FirstLastName09]
First / Last Name[entry.FirstLastName10]
Practice Management Software Information
Software Title / Vendor Name[entry.SoftwareTitleVendorName]
Account Number[entry.AccountNumber]
AdministratorAccountUsername/ Password[entry.AccountPassword]