Site Survey Checklist - VirTech - Virtua Technology Solutions

Does the dedicated PC meet the 1 GB RAM recommendation? Yes □ No □(512 MB Minimum Required)System Integration:Does the practice currently own or plan to purchase a practice management software product?Yes □No □If yes, which product?_________________________________ (Please provide product name and version number)Does the practice currently own and use an imaging software product?Yes □No □If yes, which product?_________________________________ (Please provide product name and version number)How many PC’s will utilize the imaging software product being purchased with the 8000C system?________Do all the PC’s that will be used for viewing purposes meet the minimum 512 MB RAM requirement? Yes □ No □(1 GB Recommended)ServicesWill the removal and disposal of shipping crates be handled by the NSP? Yes □ No □Does the practice require removal of an existing pan or ceph? Yes □ No □(If yes, please obtain quote from NSP)Is the customer aware that initial training will be provided by the NSP? Yes □ No □AcknowledgmentsCustomer InitialSystem requirements were provided to and reviewed with customer? Yes □ No □ _____On-site measurements reviewed and approved by customer? Yes □ No □ _____Drawing of room layout, dimensions, and additional notes complete? Yes □ No □ _____Reviewed that installation and initial training to be provided by NSP? Yes □ No □ _____SIGNATURES REQUIRED PRIOR TO INSTALLATION:PRACTICEWORKS or NSP:Date:I have read and fully understand the System Site Requirements and Practice Responsibilities set forth on this Site Survey Checklist andacknowledge that I have reviewed each one of them with a representative of Kodak Dental Systems or one of Kodak Dental Systems’certified NSP’s.PRACTICE AUTHORIZATION:Authorized SignatoryDate:“Our Vision” is to develop, provide, and support information and imaging systems for dental professionals sothey can better focus on what they do best: care for their patients.Kodak is a trademark of Eastman Kodak Company.

ROOM LAYOUT AND DIMENSIONSPlease be preciseAdditional notes and comments:Client Confirm (initials) ___________