Mogen wij u vragen onderstaand formulier in te vullen? Dankzij de ProgramIdentification kunnen wij u in de toekomst gericht verder helpen.

Indien u over meerdere software pakketten beschikt, gelieven het formulier in te vullen per software pakket?

    Software House - Full Name (required)

    Software - Full Name (required)

    ProgramIdentification (required)
    Software vendor identification for Recip-e web service calls
    PDF - Software vendor identification

    Prescriber/ Excecutor Software (required)

    Hospital/Non-hospital (required)

    Contact - general helpdesk or designated contact (required)

    Free text - Any relevant comment
    E.g. Software for dentists, ophthalmologists, midwives, ...
    E.g. Future/previous name of the software/software house
    E.g. New contact