Health Information Technology

Physicians' Interest Survey

Are you interested in a free practice assessment?


If so, please fill out the following form:

*Indicates Mandatory Field

Physician's Information




























Please Specify Other Practice Specialty

Number of Locations

How many years have you been in practice?

What Systems Do You Currently Have In Place?
Practice Management

Please Specify Other Practice Management System

Electronic Health Records (EHR)

Please Specify Other Electronic Health Records

Revenue Cycle Management

Please Specify Other Revenue Cycle Management System

What Are Your Short Term and Long Term Goals for the Practice?
What are your short term goals for the practice? (Ex: decrease operational costs) Select all that apply. Hold down the control key to select more than one option.

Please Specify Other Short Term Goals

What are your long term goals for the practice? Select all that apply. Hold down the control key to select more than one option.

Please Specify Other Long Term Goals

What Is Your Biggest Difficulty with the Current, Paper-Based Workflow?
Workflow Difficulty:
Other Workflow Difficulty

EHR
Any fears or concerns with moving to EHR? (Select all that apply. Hold down the control key to select more than one option.)

Other Concerns

Do you have a research interest?