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Software Satisfaction Survey
1. Only 12 questions! Demographic, Experience, and Decisions
Agency info will not be shared or sold. Data will be utilized soley for study purposes
1
. Agency Location
Agency Location
City
State
2
. Size of agency
Size of agency
0-25 active patients
26-50 active patients
51-75 active patients
76-100 active patients
101-150 active patients
151-200 active patients
200+ active patients
other
Other (please specify)
3
. How long have you been Medicare certified?
How long have you been Medicare certified?
Not certified
Pending certification
0-1 year
2-4 years
> 5 years
4
. What is your agency's annual gross revenue (may estimate)?
What is your agency's annual gross revenue (may estimate)?
< $1 million
$1-$3 million
$3-$5 million
>$5 million
5
. Services (select all that apply)
Services (select all that apply)
Home Health
Hospice
Private Duty
Infusion Nursing
Pediatrics
Telehealth
Other
Other (please specify)
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