How many persons in your practice? (including full-time, part-time & contract workers)
*
1
2-5
6-24
24-99
100+
Do you have an in house assistant?
*
Yes
No
Do you use the internet?
*
Yes
No
Do you dictate?
*
Yes
No
Does your company have a website or blog?
*
Yes
No
If yes, what is the website URL(s)?
Do you use a mobile device?
*
Yes
No
Mobile Service Provider:
Mobile Make/Model:
Does your company have an IT department or tech?
*
Yes
No
On a scale of 1-10 (with 10 being “geek”), how would your rate your technology comfort level?
*
1
2
3
4
5
6
7
8
9
10
Is your primary e-mail:
*
Public: @Yahoo/MSN/AOL/Gmail
Private: @yourcompanydomain.com
Other
Email Provider (if other):
What does your company use to manage e-mail?
*
Outlook
Google Apps
Public: @Yahoo/MSN/AOL/Gmail
Other
Email Manager (if other):
What does your company use to manage/store documents?
Document Management Software
Private On Line Storage
Public: Yahoo/MSN/AOL/Gmail
Other
Document Management Software Used:
Private On Line Storage Used:
Public/Free Software (Yahoo, Gmail, MSN, AOL etc):
Other Software Used:
What does your company use for word processing?
*
Word
Word Perfect
Other
Word Processing Software (if other):
You need assistance primarily with:
*
Documents
Calls
E-mails
Calendar
Website
Other
You need assistance with (if other):
Any other information you feel is relevant:
Name:
*
Telephone:
*
Email:
*