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mendalia
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Mendalia
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Name
*
Phone
*
Email
*
Organization Name
*
Address
*
Position
*
Type of Setup (Checkbox – multiple select allowed)
*
General Practice / GP Clinic
Specialist Clinic
Multispecialty Clinic
Hospital (Private
Hospital (Public)
Diagnostic Lab / Imaging Center
Telehealth Provider
HealthTech Company / Integrator
Other
Number of Practitioners Using Mendalia
*
1 (Solo)
2–5
6–15
16–50
50+
Other
Intended Use (Multiple select allowed)
*
Real-time consult support (live patient assessments)
Report interpretation (labs, scans)
Differential diagnosis suggestions
Education / training use
EHR integration
Research / Audit trail purposes
Pilot trial / Limited deployment
Other
Integration Preferences (Select one or more)
*
Use via Mendalia web dashboard (no integration needed)
EHR integration (write-in EHR system name)
API access
Other custom deployment (explain below)
Data Privacy / Compliance Needs. Are there specific privacy standards we need to comply with in your region or organization?
*
HIPAA
GDPR
Australia Privacy Act
Local hospital/clinic-specific standards
Not sure / please advise
Usage Estimate (Pick the closest). How many patients per month will Mendalia be used with (approx.)?
*
<50
50–200
200–1,000
1,000–5,000
5,000+
Anything else you'd like us to know?
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