i.e. Dr. Joe Smith
Direct Phone Number
Current patient base:
500 - 1000 patients
1,001 - 2,500 patients
Do you accept Medicare?
What are the main insurance providers that you work with?
Type the main insurance providers here
How many Advanced Practice Providers (Nurse Practitioners / PAs) are in your clinic?
Patient communication information
How do you currently communicate to your patients?
For example: MyChart, Email Mailing System, etc
If you email your patients, what email system do you use?
Approx. how many patients do you reach out to on a monthly basis?
Do you use social media to talk with your patients?
Should be Empty: