Hill View Services Agreement
Hill View, Inc.
RR 2 Box 3107
Union Dale, PA 18470
web site: www.hillview.com email: teamhvi@hillview.com
tel: 570.679.9679 fax: 570.679.9670
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Hill View Services Agreement |
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Hill View, Inc. RR 2 Box 3107 Union Dale, PA 18470 web site: www.hillview.com email: teamhvi@hillview.com tel: 570.679.9679 fax: 570.679.9670 |
| Please read, fill in and sign the
following agreement for the Internet Service (to be used by Symptom
Survey Maestro), provided by Hill View, Inc..
We will provide for your office a secured segment of a master web site (www.DoMySurvey.com), dedicated to providing your patients with a secure area to fill out and submit Symptom Surveys. You will be able to interface to this web site directly, using your licensed copy of Symptom Survey Maestro, over a secured channel, to download completed patient surveys, along with being able to perform regular maintenance functions like creating and changing patient accounts. Each patient account will be secured by use of a login name (email) and password (assigned by you), which can be changed at any time. If you would like this web site to be integrated within your own web site, please contact Hill View for pricing and scheduling information. The pricing spelled out in this contract is guaranteed only for the contract period specified. These prices are subject to change without notice after your contract period. We will use our best efforts to keep all Doctor (or Clinician) and Patient (or Client) information secure and confidential. All access is secured with a name/password combination, over a secured channel. For regular maintenance, and to diagnose any problems that may arise, we may occasionally review (and modify) the database, but we will not disclose their contents to anyone outside of your organization, employees, suppliers or our organization, employees, suppliers; and only on a need to know bases. We do regular backups of your data located on our servers, but it is your responsibility to backup your data on your PC(s). By signing this contract, you acknowledge you have read and understand and agree to the above terms and conditions. |
| Practice Name:_________________________________________________________ Contract Period is for ________ months @ $_________________ per month
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| Please print this form and mail or fax this completed form to: |
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