Practice Assessment 2020 - Powered by Keap

Filling out this practice assessment will help us understand the therapeutic modalities you are interested in. It will also allow us to present additional services that may improve patient care and increase your practice's bottom line.

Title *

First Name *
Last Name *

Email *

Phone *

What is the name of your practice? *

What State(s) is your practice located In? (Hold CTRL key to select multiple States) *

How many practitioners are on staff? (MDs, Dos, ARNPs and PA-Cs only) *

How many patients does your practice see per week? *

1-5051-100101-200200+

Percentage of male patients? *

Percentage of female patients? *

Which best describes your current practice model? *

What therapies are you interested in offering at your practice? (Hold CTRL key to select multiple options) *

Diagnostic Lab Services

Do you currently draw blood in-office? *

YesNo

What does your payor mix look like?

Please provide approximate percentages for each of the below. Answers should add up to 100%

Private Insurance HMO

Private Insurance PPO

Federal Insurance Tricare/United

Medicare or Medcare Advantage

Self-pay

What can we assist you with? *

Schedule a review of your practice assessment with David Caddell to go over your practice's needs. *

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming