We offer a one-week free trial of our services. To start the Trial, please fill-in the following information and click ‘Submit’. For any questions, please contact us at corporate@burrak.com Free Trial Request Form Name*   E-mail*   Phone*   Fax Medical specialty No. of doctors in practice Approx. transcription volume Lines transcribed / month Minutes dictated / month Monthly transcription bill Patients visits per day Others Please specify How would you like to record/send dictation? Toll-free Telephone Service Digital Handheld Recorder Make Model Connect and download from our Dictation Server Report Formats I want to use Burrak – Data Solutions standard formats during the trial OR I want reports customized to my formats during the trial Max Upload 2 MB or simply fax your formats to (773) 584-0881 How did you hear about us? E-Mail Customer Referral Others Please Specify Promotional ID Customer Name Additional Information