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* 1. What is the name of healthcare facility that you work for?

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* 2. Where is the facility located?

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* 3. Name of person completing this survey:

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* 4. Contact phone number:

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* 5. What are the key healthcare uses of the internet or other network services, that are necessary on a day to day basis at your organization, where having efficient and reliable broadband service is essential?

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* 6. Are the right hardware, software and other tools in place for healthcare providers to utilize broadband in your region?

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* 7. If YES, what tools are in place? If NO, what hardware, software and other equipment do you need?

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* 8. Do you feel you have enough choices for broadband carriers in your region?

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* 9. If your answer to the previous question was "No", how many providers do you feel would be an ample number to choose from?

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* 10. Please provide examples of how having the right hardware, software and other tools in place to utilize broadband would improve today's healthcare industry in your region.

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* 11. Do your facility or organization's current processes and procedures encourage the use of broadband?

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* 12. Does your facility or organization’s broadband access and availability meet minimum standards for effective healthcare applications?

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* 13. If your answer to the previous question was "YES", how? If "NO", what are the locations that need broadband enhancements and the challenges in getting it there?

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* 14. Is broadband technology cost prohibitive?

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* 15. Overall, how important is it to your facility or organization that broadband service availability and adoption issues be addressed in your region?

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* 16. What future broadband internet needs do you anticipate for your facility?

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* 17. Would you or someone from your facility be willing to serve on a committee to review healthcare broadband internet needs?

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* 18. If yes, please provide your contact information.

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