Lead Referral Program: Lead Submission Form | MicroMD
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Lead Referral | MicroMD

New Lead Submission Form

HSMS Lead Referral Program

Welcome to the HSMS Lead Referral Program! Please complete all the fields on this form to submit your qualified lead.

What’s next?

  • Once we receive your qualified lead, the MicroMD Lead Qualification team will enter it into our CRM for payment, follow up and sales status tracking.
  • The Lead Qualification team will then deploy the lead to the appropriate MicroMD Area Sales Manager (ASM) or Value Added  Reseller (VAR) contact.
  • The designated MicroMD sales contact will follow up with you to confirm lead receipt and to gather an additional information needed for managing the sales process.

If you do not have follow up from the sales contact within 48 hours, please feel free to contact angelina.rendon@henryschein.com.

Thank you for your submission.

– Henry Schein MicroMD

  • Fields marked with a * are required.

    Lead Submitter Information

  • Lead Information

  • This field is for validation purposes and should be left unchanged.
***As a reminder, in order for a lead to be considered qualified for referral compensation, the lead must:
  • Have confirmed interest in changing to a new PM and/or EMR software or that is planning to implement PM and/or EMR for the first time within the next 12 months.
  • Have provided approval to the Lead Referrer to have a MicroMD sales representative contact them to schedule a software demonstration and/or receive a price quote
  • Include valid contact information
  • Be within the approved specialty or organization types listed per the “MicroMD Target Market List” for both PM and/or EMR
  • Include required lead fields of information as outlined in the “Lead Submission Process”
  • Not have been in direct contact with an ASM or VAR within the last 90 calendar days per the MicroMD CRM (Lead entered in the CRM with “Probability of Close” = 25% and/or direct contact meaning that a phone call or email from an ASM or VAR that generated a response from a contact)