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Co-Op Pay Payments Processing
& Automation

Purpose of This Questionnaire

Co-Op Pay is a payments and automation technology provider. Specifically, the Co-Op Pay Synapse software component is a locally installed software which enables payment processing and auto-posting of payments back into the practice EMR or practice management system. This short assessment is designed to collect basic information on the IT environment and processes involving the EMR/PM system. These responses will help us prepare for, and support, a successful install and ongoing utilization of the Co-Op Pay Synapse software, as well as evaluate compatibility and alignment with our mutual business and security requirements.

Confidentiality Notice:

All information submitted through this form is treated as confidential and will be used solely for evaluation and development purposes by the internal Co-Op Pay team. By continuing, I confirm the information provided is accurate and understand the purpose and confidentiality statements above.

Please answer all the information below. *Indicates Required information.

CONTACT INFORMATION
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PMS/EMR/HMS Details
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Installation & Privileges
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Security
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File system & templates
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Multi-user/Shared PC
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licensing
Acknowledgement
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NOTES

Support

For all other questions, please contact Customer Care at (833) 572-6682, or send an email to support@lqpay.ai.