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Name of facility
   
 
 
 
Name of person completing survey:
   
 
 
 
Address & Phone number of facility:
   
 
 
 
E-mail Address:
   
 
 
 
PRODUCT INTEREST

Please indicate the types of products you may be interested in purchasing or learning more about:
 
Restorative Care Software
 
Trend Analysis Software
 
Reports Generator
 
Assignment Sheet Generator
 
Infection Control Software
 
Other
 
 
 
 
To help us serve you better, please tell us about your facility:

Number of beds at your facility
 
1-50
 
50-100
 
100-150
 
150-200
 
200+
 
Other
 
 
 

What operating system is your facility currently using?
 
Windows XP
 
Windows 2000
 
Windows ME
 
WIndows 98
 
Other
 
 
 
 
Annual budget for this product category:

 
$0-$10K
 
$10K-$50K
 
$50K-$100K
 
$100K+
 
Other (Please Specify)
 
 
 
 
Who is involved with purchasing decisions?
 
Buying team
 
Corporate CFO
 
Administrator / Director
 
Name of represenative
 
 
 

Has your facility recieved fines or "tags" in the last few years?
 
Yes
 
No
 
 

What percentage of your facility is currently recieving restorative care?
 
0-25%
 
25-50%
 
50-75%
 
75-100%
 
 
 
Thank you!
Your patience is appreciated.
 
 
 
Permission to contact you via e-mail?
 
Yes
 
No
 
Please contact [email protected] if you have any questions regarding this survey.
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