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  1. Surveys
  2. 2017
  3. February
  4. O
  5. Office Assessment
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Questions marked with a * are required Exit Survey
 
 
* What is the name of your practice(s)?
   
 
 
 
* First Name : 
* Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
Phone : 
* Email Address : 
 
 
 
* Which Practice Management Software do you use?
 
 
 
* Are you set up for electronic claims?
 
Yes
 
No
 
I don't know
 
 
 
* Do you use digital or film x-rays?
 
Digital
 
Film
 
Other
 
 
 
 
* What types of insurances do you accept?
 
PPO's
 
HMO's
 
Workers Compensation
 
Medicaid
 
Other
 

 
 
 
* What type of computers are used in your office?
 
MAC
 
PC
 
Other
 
 
 
 
* How many doctors are practicing at this location?
   
 
 
 
* What is your average monthly production?
 
Under $20,000.00
 
Between $20,000.00 and $50,000.00
 
Between $50,000.00 and 100,000.00
 
Over $100,000.00
 
 
 
* On average, how much do you collect from insurance companies monthly?
 
Under $20,000.00
 
Between $20,000.00 and $50,000.00
 
Between $50,000.00 and $100,000.00
 
Over $100,000.00