* 1. Please complete the following information about yourself and your practice.

* 2. How many providers are in your practice?

* 3. Have you evaluated an Electronic Health Record for your practice?

* 4. If yes, Which EHRs have you evaluated?

* 5. What do you see as the barriers to implementing an EHR? Please select all that apply.

* 6. Do you see your practice implementing an EHR in the future?

* 7. If yes, when?

* 8. If yes, which EHR

* 9. Do you know about the benefits offered by CIQN?

* 10. Would you like additional information about CIQN or would you like us to schedule a demonstration..

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