1. Please indicate the approximate number of Annual Patient Appointments at your location (in- and outpatient total): Under 100,000/year 100,000 - 300,000/year 300,000 - 500,000/year Over 500,000/year
2. How many departments and/or clinics are at your facility (including offsite offices and clinics)? Under 20 20 - 50 Over 50
3. Number of doctors affiliated with your facility: Under 20 20 - 50 50 - 100 Over 100
4. How do you confirm/remind patients of their scheduled appointments now? Phone Mail Phone and mail Other
5. What scheduling software do you use? Is there a brand name?
6. Do you currently mail out any directions, maps, or special instructions to patients? Yes No
7. Who is Vice President of Ambulatory Services and/or Patient Access Services at your facility? Name: Phone: E-mail:
Name:
Title:
Organization:
Address:
City: State: Zip:
Phone:
E-mail: