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Treatment Form

I run a LASIK surgery center. We have a treatment form that we require referring doctors to complete and send to us for every patient that we treat. I'm having trouble getting doctors to complete the entire form, so what I would like to do is have someone build our EXACT form electronically and make it so doctors cannot submit the form to us without every data field required being completed. it would be great if they could also electronically sign the form stating that the data is accurate and complete.

Compétences : Programmation C, Formulaires électroniques, Médical

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Concernant l'employeur :
( 0 commentaires ) United States

N° du projet : #1657357

12 freelance ont fait une offre moyenne de 195 $ pour ce travail

scribblerspk

I am interested doing your project, for more details kindly see your mail box. Thanks, Faisal.

250 $ USD en 20 jours
(3 Commentaires)
4.6
travelerbd

Want to delivery a quality work with reduced [url removed, login to view] PM for sample form. Thanks.

50 $ USD en 4 jours
(4 Commentaires)
3.3
HardWorker1989

Hello Dear Sir / Ma'am. I am a highly qualified & certified Adobe Acrobat , Adobe LiveCycle Form Designer and MS OFFICE professional with more than 4 years of teaching experience for these softwares in an institute. Plus

60 $ USD en 0 jours
(9 Commentaires)
3.2
vkbansallx

hi this is a long form. it is not clear whether doctors have to fill all the fields or their are some alternate fields , i.e., doctors must fill either of them , e.g. LEFT EYE Sphere Cylinder Axis Date will a d Plus

250 $ USD en 30 jours
(0 Commentaires)
0.0
techfreelancer1

Please check PMB

250 $ USD en 5 jours
(0 Commentaires)
0.0
bpreeya22

plz check you PM.

250 $ USD en 10 jours
(0 Commentaires)
0.0
teamvalid

Hi there! I can get the job done for you in a matter of day. The only thing I need to is if you want the form electronically on the web(online) or you need it as an application that's executable on a click on any Windo Plus

200 $ USD en 1 jour
(0 Commentaires)
3.6
X7K0I8juF

Custom software development - <b><i>Removed by Admin</i></b>

250 $ USD en 1 jour
(0 Commentaires)
0.0
alexanderonline

Greetings, I assume that you have a web-site with database. I have done a lot of similar tasks using various technologies (PHP, .NET, ColdFusion) so I think I can easily do the job for you. If you'd prefer a l Plus

500 $ USD en 7 jours
(0 Commentaires)
0.0
chetanparekh19

Expert in software development. Hope have a great business together.

175 $ USD en 2 jours
(0 Commentaires)
0.0
socialGaurav

I have created a demo of your form. Please check your PMB for details

150 $ USD en 5 jours
(0 Commentaires)
0.0
adaschevici

Hello. I can have this built electronically and validation of the form when the doctor tries to submit it. Check pmb for questions. Regards, -Arthur

150 $ USD en 4 jours
(0 Commentaires)
0.0
sanjaygarai

I can do [url removed, login to view] check pm for details.

60 $ USD en 1 jour
(0 Commentaires)
0.0