OSU Department of Biomedical Informatics

BMI Consulting Services Form

Please fill-in the form below so that we may better understand your needs and objectives.

Personal Information

First Name:
Last Name:
Date:
Names of Others on Project:

Organization Information

Organization Name:
Main Area of Business
Products and/or services offered:
Address:
Phone Number:
Email:

Consultation Information

Desired Date(s):
Previous Consultation
Have you consulted with any BMI personnel about this project? Please describe :
Area of Expertice:
Category of Service:
Project Summary: