DispenSense Site Survey
Pharmacy Name
*
Current Dispensary System
*
MPS
Touchstore
Helix Plus
Helix.NET
Other
Contract Expiry Date
 -
Day
 -
Month
Year
Date
Internet Upload Speed
*
Specify units (mbps, kbps, gbps)
Internet Download Speed
*
Specify units (mbps, kbps, gbps)
REMINDER: Make sure you check WiFi speeds in various spots around the shop. Are the WiFi speeds above 10mbps download?
*
Yes
No
FMD Provider
*
MPS
Touchstore
Helix
Quick Pharm
Other
Other FMD Provider
*
Nursing Home
*
Yes
No
How many patients?
*
Nursing Home extra info
Robot in Pharmacy
*
Yes
No
What type of robot?
*
AntiVirus
*
Yes
No
Brand of Antivirus
*
This can be found in windows "Antivirus & Treat Protection"
Do you want Healthmail Processing
*
Yes
No
Are there any A4 Printer/Scanner in the pharmacy
*
Yes
No
If yes, how many?
*
Is the scanner on the A4 printer being used?
*
Yes
No
General Pharmacy Images
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Current Hardware
Number of Dispensary PCs
*
1
2
3
4
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PC 1 Hardware Specs
PC 1 Device Name
*
PC1 Type
*
All in One PC
Tower PC & Monitor
PC1 Mouse Type
*
Wired
Wireless
PC 1 Keyboard Type
*
Wired
Wireless
PC 1 Monitor Resolution
*
1920 x 1080
Other
PC 1 Other Monitor Resolution
*
PC 1 Network Connection
*
WiFi
LAN (Wired)
PC 1 Does PC have WiFi capability?
*
Yes
No
PC 1 Processor
*
i3 Core
i5 Core
i7 Core
Other
PC 1 Other Processor
*
PC 1 RAM
*
4GB
8GB
16GB
Other
PC 1 Other RAM
*
PC 1 System Type
*
32 bit (x32)
64 bit (x64)
PC 1 Windows Edition
*
Windows 7
Windows 10
Windows 11
Other
PC 1 Is the PC upgradable to Windows 11
*
Yes
No
PC 1 Image of Windows 11 update status
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 1 Storage Type (found in task manager)
Hard Disk Drive (HDD)
SSD
Other
PC 1 Available Storage
*
Specify MB or GB
Connected Devices
PC1
PC 1 Label Printer
*
Yes
No
PC 1 Document Scanner
*
Yes
No
PC 1 FMD Scanner
*
Yes
No
PC 1 Dot Matrix Printer
*
Yes
No
PC 1 Label Printer Model
*
PC 1 Document Scanner Model
*
PC 1 FMD Scanner Model
*
PC 1 Dot Matrix Printer Model
*
PC 1 Dot Matrix Printer Connection
*
USB
Serial
PC 1 If serial, does it have a USB port
*
Yes
No
PC 1 Dot Matrix Printer Connection Image
*
Browse Files
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Choose a file
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of
PC 1 Are any Printers Shared from this PC?
*
Yes
No
PC 1 Which devices are shared?
*
PC 1 Additional Notes
PC 1 Images. Please include pictures of wall ports, power, pc specs and all printers
*
Browse Files
Drag and drop files here
Choose a file
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of
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PC 2 Hardware Specs
PC 2 Device Name
*
PC 2 Type
*
All in One PC
Tower PC & Monitor
PC2 Mouse Type
*
Wired
Wireless
PC2 Keyboard Type
*
Wired
Wireless
PC 2 Monitor Resolution
*
1920 x 1080
Other
PC 2 Other Monitor Resolution
*
PC 2 Network Connection
*
WiFi
LAN (wired)
PC 2 Does PC have WiFi capability?
*
Yes
No
PC 2 Processor
*
i3 Core
i5 Core
i7 Core
Other
PC 2 Other Processor
*
PC 2 RAM
*
2GB
4GB
8GB
Other
PC 2 Other RAM
*
PC 2 System Type
*
32 bit (x32)
64 bit (x64)
PC 2 Is the PC upgradable to Windows 11
*
Yes
No
PC 2 Image of Windows 11 update status
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 2 Windows Edition
*
Windows 7
Windows 10
Windows 11
Other
PC 2 Other Windows Edition
*
PC 2 Storage Type
*
Hard Disk Drive (HDD)
SSD
Other
PC 2 Storage Available
*
Specify MB or GB
Connected Devices
PC2
PC 2 Label Printer
*
Yes
No
PC 2 Document Scanner
*
Yes
No
PC 2 FMD Scanner
*
Yes
No
PC 2 Receipt Printer
*
Yes
No
PC 2 Label Printer Model
*
PC 2 Document Scanner Model
*
PC 2 FMD Scanner Model
*
PC 2 Dot Matrix Printer Model
*
PC 2 Dot Matrix Printer Connection
*
USB
Serial
PC 2 If serial, does it have a USB port?
*
Yes
No
PC 2 Dot Matrix Printer Connection Image
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 2 Are any peripherals shared from this PC
*
Yes
No
PC 2 What devices are shared?
*
PC 2 Additional Notes
PC 2 Images, Please include pictures of wall ports, power, pc specs and all printers
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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PC 3 Hardware Specs
PC 3 Device Name
*
PC 3 Type
*
All in One PC
Tower PC & Monitor
PC3 Mouse Type
*
Wired
Wireless
PC3 Keyboard Type
*
Wired
Wireless
PC 3 Monitor Resolution
*
1920 x 1080
Other
PC 3 Other Monitor Resolution
*
PC 3 Network Connection
*
WiFi
LAN (wired)
PC 3 Does PC have WiFi capability?
*
Yes
No
PC 3 Processor
*
i3 Core
i5 Core
i7 Core
Other
PC 3 Other Processor
*
PC 3 RAM
*
2GB
4GB
8GB
Other
PC 3 Other RAM
*
PC 3 System Type
*
32 bit (x32)
64 bit (x64)
PC 3 Is the PC upgradable to Windows 11?
*
Yes
No
PC 3 Image of Windows 11 update status
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 3 Windows Edition
*
Windows 7
Windows 10
Windows 11
Other
PC 3 Other Windows Edition
*
Storage Type
*
Hard Disk Drive (HDD)
SSD
Other
PC 3 Available Storage
*
Connected Devices
PC 3
PC 3 Label Printer
*
Yes
No
PC 3 Document Scanner
*
Yes
No
PC 3 FMD Scanner
*
Yes
No
PC 3 Receipt Printer
*
Yes
No
PC 3 Label Printer Model
*
PC 3 Document Scanner Model
*
PC 3 FMD Scanner Model
*
PC 3 Dot Matrix Printer Model
*
PC 3 Dot Matrix Printer Connection
*
USB
Serial
PC 3 If serial, does it have a USB port?
*
Yes
No
PC 3 Dot Matrix Printer Connection Image
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 3 Any peripherals shared from this PC
*
Yes
No
PC 3 What devices are shared?
*
PC 3 Additional Notes
PC 3 Images, Please include pictures of wall ports, power, pc specs and all printers
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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PC 4 Hardware
PC 4 Device Name
*
PC 4 Type
*
All in One PC
Tower PC & Monitor
PC4 Mouse Type
*
Wired
Wireless
PC4 Keyboard Type
*
Wired
Wireless
PC 4 Monitor Resolution
*
1920 x 1080
Other
PC 4 Other Monitor Resolution
*
PC 4 Network Connection
*
WiFi
LAN
PC 4 Does PC have WiFi capability?
*
Yes
No
PC 4 Processor
*
i3 Core
i5 Core
i7 Core
Other
PC 4 Other Processor
*
PC 4 RAM
*
2GB
4GB
8GB
Other
PC 4 Other RAM
*
PC 4 System Type
*
32 bit (x32)
64 bit (x64)
PC 4 Is the PC upgradable to Windows 11
*
Yes
No
PC 4 Image of Windows 11 update status
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 4 Windows Edition
*
Windows 11
Windows 10
Windows 7
Other
PC 4 Other Windows Edition
*
PC 4 Storage Type
*
Hard Disk Drive (HDD)
SSD
Other
PC 4 Available Storage
*
Connected Devices
PC 4
PC 4 Label Printer
*
Yes
No
PC 4 Document Scanner
*
Yes
No
PC 4 FMD Scanner
*
Yes
No
PC 4 Dot MatrixPrinter
*
Yes
No
PC 4 Label Printer Model
*
PC 4 Document Scanner Model
*
PC 4 FMD Scanner Model
*
PC 4 Dot Matrix Printer Model
*
PC 4 Dot Matrix Printer Connection
*
USB
Serial
PC 4 If serial, does it have a USB port?
*
Yes
No
PC 4 Receipt Printer Connection Image
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PC 4 Are any peripherals shared from this PC?
*
Yes
No
PC 4 What devices are shared?
*
PC 4 Additional Notes
PC 4 Images, Please include pictures of wall ports, power, pc specs and all printers
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Pharmacist Confirmation
Image of labels for setting Template
*
Browse Files
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Are any additional terminals needed?
*
Yes
No
If yes, which devices do they need?
*
Does the pharmacy want a like for like setup or do they want to add devices to some workstations?
*
Like for Like
Additional devices required
List addition devices here
*
Additional Notes if needed
Submit
Should be Empty: