MIPS Survey page

Please complete this quick survey to reserve your Medical Data or MIPS Strategy session with Dr Bart

* Indicates required field

Name *

First

Last

Email *

Your goals with MIPS ? *

Education - minor implementation assistance Education - complete implementation assistance Education only

Phone or Skype Number *

If Other ways we can assist please specify: *

Hours per week to collect medical data or MIPS details : *

Less than 10 10-20 21-30 31-40 41-50 Over 50 Prefer not to say

Goals with medical data: *

Obtain structured raw data for evaluation Obtain structured data with analyzation assistance

Proudly powered by Weebly