Electronic Health Record (EHR) and Scheduling Platform Survey
Provider Information
Provider Name
Enter the name of your facility, group, or individual practitioner.
NPI
What (if any) platform/tool do you use to manage scheduling patients?
Please select...
Do not have one/None
AMD
Apple Calendar
Athena
Cerner
EClinical Works
Epic
Google Calendar
InSync
Kareo
Microsoft Outlook
Non-digital calendar
Simple Practice
Theraplatform
Therasoft
Therapy Notes
Valant
Other
Other:
What Electronic Health Record (EHR) system, if any, do you use for managing patient care?
Please select...
Do not have one/None
AMD
Athena
Cerner
EClinical Works
Epic
InSync
Kareo
Simple Practice
Theraplatform
Therasoft
Therapy Notes
Valant
Other
Other:
Attestation
By checking here, you are verifying that you are the provider who completed this form or, if completing for a provider, that you have the authority to complete this form on behalf of that provider.
I agree
Name
Position/Title
Email
Date
Contact Information