BioTracker Needs Analysis Form
Please complete the form below. We'll be back with you within 24 Hours
Full Name
*
First Name
Middle Name
Last Name
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Medical Practice / Company Name?
*
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Email Address
*
example@example.com
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What type of clinic do you operate?
*
Please Select
Primary Care - Family Medicine
Internal Medicine
Cardiology
Other
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On average, how many fee-for-service (non-capitated) patients does your clinic see per day?
*
Please Select
Fewer than 50
51-100
101-200
More than 200
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Roughly what percentage of your patient base has commercial insurance (e.g., PPO, EPO, private plans)?
*
Please Select
Less than 25%
25%–49%
50%–74%
75% or more
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How many patients PER DAY do you estimate would be eligible for a diagnostic program like ours?
*
Patients must typically meet clinical necessity and have commercial insurance.
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How often do your typical patients return for follow-up visits?
*
Please Select
Less than 30 days
Every 30–60 days
Every 60–90 days
90 days or longer
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Best Time of Day to Schedule a Brief Call / Zoom?
We can send you 2-3 choices for a 20 Minute Discovery Call or Zoom
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