1. Section A: Organization Data

Disclaimer: This Gap Assessment survey is being conducted by Spectrum Health Care. Our aim is to learn more about health care providers, associations and partnerships between organizations, and gaps in services for our patients/clients in our 37-county service area. The results will provide information that will help Spectrum Health Care with strategic planning in 2020 to better meet the needs of our patients and clients. The information gleaned from the assessment will result in a final report of any significant findings and will serve as an internal planning tool only. The report will not be published. We will make available a copy of the report to any participating organization upon request. You are being invited to participate in the survey because you are a key health care partner and stakeholder in our service region. The procedure involves completing an online survey (Survey Monkey) that will take approximately 15-20 minutes. If you prefer a survey interview by phone, or to complete a pencil-paper version of the survey, please contact Christy Stretz at cstretz@spectrumhealthcare.org or (573) 875-8687. To learn more about us, please visit our website at www.spectrumhealthcare.org.

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* 1. Organization Name:

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* 2. Street:

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* 3. City:

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* 4. ZIP:

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* 5. County:

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* 6. Administrator:

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* 7. Title:

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* 8. Phone:

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* 9. FAX:

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* 10. Email Address:

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* 11. Hours of Operation:

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* 12. Website URL:

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* 13. Person Completing this Survey:

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* 14. Phone:

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* 15. Email Address:

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