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* 1. Do you have a need for greater access to Phlebotomy?

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* 2. Lab Name

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* 3. Is your need: (Check all that apply)

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* 4. What is your current solution for Phlebotomy collections? (Choose all that Apply)

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* 5. Where do you need access to Phlebotomy the most?

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* 6. What is your greatest need when it comes to access to Phlebotomy? (Check all that apply)

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* 7. Do you provide Patients with "KITS" with all the instructions and supplies?

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* 8. Typical Collection consists of (Check all that apply):

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* 9. Typical Collection Requires:

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* 10. Do you currently have an option for a Patient to Pay for the phlebotomy collection?

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* 11. What is the amount that you (LAB) or the patient are willing to pay for your phlebotomy collection? (Choose 1)

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* 12. Do you currently offer or plan to offer a Direct to Consumer or Direct Access Testing Solution?

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* 13. How many sales representatives do you currently have?

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* 14. MOMS is building a national network of Medical Access Points (MAPS) that will serve as a brick and mortar network of collection sites. Would you like to see a demo of the MOMS Platform?

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* 15. If YES, please provide contact Information:

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