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Partners

Reseller | e-Health Portals | Inquiry Form

Specify your geographic market: * (check all that apply)
Americas Europe Asia Global

Type of Partner: *

Application Service Providers (ASPs)
Complementary Solutions - BPO
Consulting and Integration
Platform Provider (software, hardware, or equipment)
Complementary Solutions - Health Services
Complementary Solutions - Software Engineering

Vertical Specialization:
Education	Insurance
Healthcare Support Services	State/Local Government
Healthcare IT Services	Federal Government
Pharmaceutical	Other:

Company Information
Company Name:*
Salutation:*	Mr. Mrs. Ms. Dr.
First Name:*
Last Name:*
Job Title:*
Address:*

City:*
State:*	(Required only for America)
Country:*
Zip/Postal Code:*
Telephone:*
Fax:
Email:*
Web Site URL:
Company Description:

Please provide a brief overview of your company and the services you provide.

Date Established:
Held:	Public Private
Total number of Employees:
Annual Revenue (last year):
Where does your company generate its greatest revenue stream?

Partnership/Value Proposition and Business Opportunity

Please describe your company's key differentiators.

Why do you want to work with CureMD?

What is your value proposition?
How would our potential partnership add value to the market/customers?

Are you currently partnering with any CureMD’s competitors?

Is your proposition business opportunity-driven?
If so, please indicate the opportunity and approximate business potential ($).

Additional Comments: