Provider Website Survey

Tell us about yourself in less than four minutes!

CareStarter wants to hear from you. In addition to requested information, remember you can add Events to the CareStarter app right after you finish your survey (through the ADD EVENT button on this Provider Page). Thank you for taking the time to tell us about you and your resource or service. We look forward to knowing more about your work within the community!

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* 1. What is your name and title?

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* 2. What email do you prefer us to contact you at?

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* 3. What is the name of your company/organization?

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* 4. What type of resource provider are you?

Medical

Therapeutic

Educational

Family Support

Nutritional

Recreational

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* 5. Please list all insurance that you accept (N/A if does not apply to you).

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* 6. How long is the wait time for using your service? List N/A if you do not have a waitlist for your services.

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* 7. Please list any military discounts or scholarships that you offer (type in N/A if does not apply). List N/A if you do not offer discounts or scholarships for your services.

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* 8. I would be interested in speaking at one of your future CareStarter Culture of Care events and share how my organization is making a difference in the community. Please contact me at the above email to discuss when it would be the most ideal time to participate.

Yes

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* 9. I would be interested in writing occasional submissions about our services to patients and their families. Please contact me at the above email to discuss what the need is and what I am thinking about discussing.

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* 10. Please include any other questions or comments that you would like us to respond to. Please insert n/a if you have nothing else to mention in this space.