Clinical Survey

Hello:
We Solicit your assistance in participating in our Clinic survey. It will take approximately 3 to 7 minutes to complete the questionnaire.

There are no foreseeable risks associated with this project.
Our aim is to provide a reliable Errand service. Your response will enable us to serve the needs of Professionals.

If you have questions at any time about the survey, you may contact Isaac at 719-0535 or by email at the [email protected].

Thank you very much for your time and support.

Does your establishment refer patients to other Clinics or Doctors?

Yes

No

After referral of patient, is there there generally a need to have the results delivered to you right away?

Yes

No

If a service was available to your establishment which allows you to receive and deliver results or supplies at your convenience, would you be interested?

Yes

No

How often would you use this service?

If yes, please state how much you are willing to pay.

$16.50 per trip

$20 per trip

$25 per trip

$350 per month

Are there errands that your establishment would like assist with?

Yes

No

Please select the errands/service that you would like conducted on your behalf.

Bill payments

Administrative errands (deliver letters, documents etc)

purchase of office supplies/medical apparatus

Delivery pickups or drop-offs

Transport medical supplies or lab tests

If you there any are special needs or services not mentioned above that you would like offered to you, please specify .

If you are interested in this service, please provide your contact information for further discourse .

First Name :
Last Name :
Phone :
Email Address :