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On-Line Form Examples

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On-Line and Fax Back Form Examples

On-line Forms
Donation Form
Things that can be customized: Header, which credit cards are accepted
https://www.ssl-data.com/dhapp.nsf/donationg?OpenForm

On-line payment
Things that can be customized: The whole top half, which credit cards are accepted
https://www.ssl-data.com/dhapp.nsf/OPY?OpenForm

On-line Pre Registration
Things that can be customized: Almost all of it, Look over and see what is required by your hospital and you can add fields. You can not change the layout.
https://www.ssl-data.com/dhapp.nsf/OPR?OpenForm

Direct Line to the CEO
http://www.demohospital.com/dhapp.nsf/linetoceo

Volunteer
Things that can be customized: Header, and when you can volunteer times and days
https://www.ssl-data.com/dhapp.nsf/AVS?OpenForm

Employment Application
Things that can be customized: Almost all text but not the layout. Be sure to have your qualified labor counsel review your desired employment application form for compliance with your state's regulations.
https://www.ssl-data.com/dhapp.nsf/JobApplication?OpenForm

Contact Us
https://www.ssl-data.com/dhapp.nsf/ContUs?OpenForm

Fax Back Forms
Consent to Examination Form
http://www.demohospital.com/dh.nsf/View/ConsenttoExaminationForm

Foundation Donation
http://www.demohospital.com/dh.nsf/View/DonationForm

Parental Permission for Emergency Room Treatment - Example 1
http://www.demohospital.com/dh.nsf/View/ParentalPermissionforEmergencyRoomTreatment-Example1

Parental permission for Emergency Room Treatment - Example 2
http://www.demohospital.com/dh.nsf/View/ParentalPermissionforEmergencyRoomTreatment-Example2

Volunteer Application
http://www.demohospital.com/dh.nsf/View/VolunteerApplication








Demonstration Hospital | 105 Continental Place | Brentwood, TN 37027-5014 | Phone: 800-233-1470