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* 1. Organization Name

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* 2. Primary Contact Name

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* 3. Role/title

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* 4. Email address

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* 5. Which best describes your organization?

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* 6. Roughly how many behavioral health referrals does your organization handle per month?

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* 7. Primary Behavioral Health use cases (select all that apply):

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* 8. Do you currently maintain a Behavioral Health provider list or directory?

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* 9. Do you have at least one navigator or team that could participate in workflow testing?

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* 10. Are you able to participate in two structured feedback sessions per month during the program?

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* 11. How would you be interested in participating in this research? (Select all that apply)

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* 12. Are you open to participating in at least one of the following? (optional but encouraged)

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* 13. What are you hoping to improve most with this program? (select up to 3)

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* 14. Briefly describe your current biggest challenge with behavioral health placement.

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* 15. We will begin in early April, with opportunities to review designs and make recommendations on workflows. Would your users be ready to engage with the Findhelp team as early as April?

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* 16. This is a limited access program with defined scope and MVP access. Do you understand this is a collaborative program with structured feedback requirements?

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