Demo Request

Demo Request
Schedule either a web-based or onsite demo at your convenience to learn how Sage Intergy practice management software or Sage Intergy Suite - integrated Sage Intergy practice management and Sage Intergy EHR electronic health records (EHR) software - can benefit your practice.

The confidentiality of the information provided is stated in our Privacy Policy. Information indicated with an '*' is required.

Micaela Demo Request Form

Salutation:
First Name*:
Last Name*:
Practice Name*:
Medical Specialty*:
Address:
City:
State/Zip:
Telephone*:
Fax:
E-Mail*:
Number of additional offices:
Number of physician providers:
Number of non-physician providers (PA, NP, Midwife, Physical Therapist, etc.):
Average number of staff per provider:
Current software:

Our practice is requesting a demo of*:

Sage Intergy (practice management only)
Sage Intergy Suite (Sage Intergy and Sage Intergy EHR)

We are requesting a(n):

Quick Look (15 mins.)
Brief Overview (30 mins.)
Overview (1 hour)

We prefer a(n):

Web demo
Onsite demo (N/A for Quick Look, Brief Overview)

Schedule preference*:

Date* (mm/dd/yyyy):
Time (hh:mm): :

Micaela, Inc. Channel Partner/Sage Software Non-Compete Provision

* I certify that the practice named above (a) does not currently have an annual support agreement with Sage Software for medical software products such as Medical Manager and MedWare, or (b) has received a medical software demo directly from Sage Software less than 6 months from today, , or (c) is scheduled to receive a medical software demo directly from Sage Software.

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