Survey

Thank you for your participation in this survey. Once completed, we will send you a $5 Starbucks card in appreciation for your time and for helping us learn to provide better solutions for what physician practices need. Only one gift card is available per practice.

Name (required)

Email (required)

Phone (required)

Practice Name (required)

Specialty (required)

Location (required)

(City, State)

Number of Doctors in Practice (required)

I am a:

User

Decision maker

Name of Current EMR/EHR (required)

Year Implemented

Features of your current system that you like: (required)

Features of your current system that you don't like: (required)

Will your practice implement a new EMR/EHR solution in the next 6 to 12 months? (required)

Yes

Maybe

Would you like to sign up for a 20-min WebEx demo of the next-generation CareCloud solution? (required)

Yes, I'd like to receive an additional $10 Starbucks Gift Card after WebEx demo

Yes, I'd like to receive an additional $25 Restaurant Gift Card after WebEx demo

No, thanks.

This field should be left blank

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