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Your Name: *
Your Title:
Your Email Address: *
Agency Name:
Telephone Number:
Address:

How many offices do you have?

Do you use a Wide Area Network (WAN)? Yes
No
What type of network do you currently use?

How many full time users do you have?
How many part time users do you have?

Current Software:
What A/R software do you use?
What payroll system do you use?

How many visits do you have per month?

What percent of your client population is?
Medicare:
Medicaid:
Private Duty:
Other:

What features are most important to you?
Point of Care Scheduling
Billing Care Pathways
Telephony Customer Service

How soon are you planning on replacing your current software?
Within 3 months 3 - 6 Months
6 - 12 months 12+ months

General Comments

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