MD Practice Enhancement Questionaire

MD Practice Enhancement - MDPEP™ Questionnaire

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Business Phone*
Business Phone*

Web Site URL

Name of Practice

Positon*
Positon*

	Physician
	Practice Manager

Medical Specialty*
Medical Specialty*

# Physician*
# Physician*

Avg # Patients Per Day*
Avg # Patients Per Day*

Select Particular Areas of Interest

	Physician Dispensed Medications
	Customized Nutrition Program
	Aesthetics / Skin Care
	Office / Home Physiological Testing
	Personal / Professional Coaching
	Medical Supply Savings
	Electronic Medical Record Software
	Revenue Cycle - EDI / Bill / Collect
	Malpractice / Risk Management
	Financing - Accts Rec / Equipment
	Pension Planning
	Wealth / Asset Accumulation / Mgt
	Practice Valuation - Buy / Sell

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