Contract Consulting Service Request Form

In order for us to provide you with a quote for our Contract Consulting Service, please complete the form below.

Please provide the following contact information:

First Name

Last Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

E-mail

Please provide the following client information:

Client/Institution Name

Cerner Client Mnemonic

Cerner Client Number

Cerner Site/Project Contact

Cerner Site/Project Contact Telephone

Cerner Site/Project Contact Email

Cerner Site/Project Contact Pager

Please provide the following system information:

Cerner Platform

Operating System

What is the projected duration of this consulting engagement?

Please describe the consulting services you need in as much detail as possible:

Are there any special or unusual considerations?        Yes      No

If yes, please describe:

Will this project include ...
        system analysis
        troubleshooting existing programs
        interactive programs (requiring user-interaction)
        programs to run automatically (from operations, etc.)
        custom tables
        client training or education
        PCG Help Service

Can you provide samples of the desired output for any required programs?
        Yes       No


Paladin Consulting Group, LLC.
Copyright © 2002 Paladin Consulting Group, LLC. All rights reserved.
Revised: May 01,2004 .