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Med-X needs your help!

We are currently redesigning our website to make it a more useful tool for our case managers. To make it as user friendly as possible we are seeking your input. Please take a few moments to complete this questionnaire and click send. For your assistance, Med-X will send you a special gift.
1. Have you visited Med-X’s website before today?
2. Do you currently utilize Med-X’s services?
If you answered Yes to Question 2, what percentage of your cases do you refer to Med-X? %
3. What is your primary motivation for choosing Med-X for your cases?
(Choose all that apply)








If you checked [Other] please specify below:
4. Do you make transportation arrangement from (Choose all that apply)

5. Do you use any of the following: (Choose all that apply)

6. Would you utilize a HIPAA compliant internet based website for arranging transportations?
If yes, what device would you prefer: (Choose all that apply)
7. Does your company have a Provider Network
               If Yes to question 7, is Med-X included in it?
              If you answered No to question 7, Please provide a contact person if you would like Med-X to be included in your organizations network Name:   
Phone:    
8. What professional organizations do you belong to?  

        What Chapter?  

 

       What Chapter?    





  

 

 
9. What meetings do you regularly attend?
10. Where do you attain most of your CCM CEU’s:




     
First Name:     Last Name:
Email Address:    
Phone Number:  
Address  
City:     ST:   Zip:
This information is for: 




Thank you again for your input. We will keep you informed about the launch of our new website. We are always striving to provide you the best services in the industry!
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