1. I am a:

2. I work at a:

3. My office plans on implementing an Electronic Health Records (EHR) system

4. I feel like I:

5. My practice/clinic is considering an EHR system now because:

6. (If you are the person who would make the decision to purchase an EHR system)
When I implement an EHR system:

7. I have gotten my information about Health Information Technology from:
(List where you last got HIT information from and what you remember about it)