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Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000
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Construction/General Contractor Supplier/Manufacturer Engineering Government Architecture Education Interior Design Other (please specify) Hospital/Health Care Facility
Architect CFO, COO Engineer Facility Manager Interior Designer Vice President/Director Project Manager Other (please specify) Owner, President, CEO
Hospitals University/Medical Schools Surgery Centers Other (please specify) Medical Office Buildings Nursing Homes
Up to $1,000,000 $10 million - $24,999,999 $1 million - $4,999,999 $25 million - $100 million $5 million - $9,999,999 More than $100 million
Select digit 0 1 2 3 4 5 6 7 8 9
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Net Worth: (select only one) < $100,000 $500,000 to $1,000,000 $100,000 to $500,000 > $1,000,000 Capital To Invest: (select only one) < $20,000 $50,000 to $100,000 $20,000 to $50,000 > $100,000 When would you like to start? (select only one) Now 6-9 months 1-2 months 9-12 months 3-4 months Over 12 months 5-6 months
< $100,000 $500,000 to $1,000,000 $100,000 to $500,000 > $1,000,000
< $20,000 $50,000 to $100,000 $20,000 to $50,000 > $100,000
Now 6-9 months 1-2 months 9-12 months 3-4 months Over 12 months 5-6 months
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Number of beds in your organization: (select only one) 500 and up 100 - 199 200 - 499 1 - 99 Please indicate type of Facility / Service / Firm: (select only one) Hospital/Multi-Hospital System Managed Care Organization (HMO, PPO, Healthplans) Integrated Delivery System/Health Network Insurance Company University/Teaching Medical Center/Hospital Third Party Administrators (TPA)/Self-Insured Employer Military/Government Medical Center/Hospital Pharmacy/Independent Lab Clinical/Group Practice IT Consulting/Systems Integration Physician Organization (IPA/PHO) Consulting Firm Ambulatory Care Center VAR/Vendor of Systems Long-Term/Sub Acute Care Facility/Nursing Home/Rehab Other (please specify) Home Health Care Agency Please select the category that best describes your title: (select only one) General and Financial Management Information Management cont. CEO, President, Executive Director, Administrator Other IT Personnel (please specify) CFO, Finance Director/Manager CSO/Security Officer/Director Network/MIS/Data Processing Director/Manager Planning Officer/Director Health Information Director/Manager Marketing Officer/Director Coding/DRG Director/Manager COO, VP, Assistant Administrator Systems Administrator/Analyst/Network Specialist/Project Manager CCO, Compliance Director/Manager Clinical Management CPO/Purchasing/Materials Management Director/Manager Chief of Staff/Medical Director/VP of Medical Affairs Quality Officer/Director Chief of Pathology/Pathologist Other Administrative Title (please specify) Chief of Radiology/Radiologist Other Clinical Administration (please specify) Information Management CIO, VP of Information Systems, Tech Officer Chief of Laboratory Services/Lab Administrator Chief of Medical Records/Medical Records Manager Chief of Pharmacy/Pharmacist Director/Manager of Medical Informatics Chief/VP of Nursing Services/Asst Director/Case Manager Director/Manager of Telecommunications/Call Center Director/Manager Other Title (please specify) What is the number of employees in your entire organization? (select only one) less than 50 1,000 - 4,999 50 - 450 5,000 - 9,999 451 - 750 10,000 - 19,999 751 - 999 20,000+
500 and up 100 - 199 200 - 499 1 - 99
Hospital/Multi-Hospital System Managed Care Organization (HMO, PPO, Healthplans) Integrated Delivery System/Health Network Insurance Company University/Teaching Medical Center/Hospital Third Party Administrators (TPA)/Self-Insured Employer Military/Government Medical Center/Hospital Pharmacy/Independent Lab Clinical/Group Practice IT Consulting/Systems Integration Physician Organization (IPA/PHO) Consulting Firm Ambulatory Care Center VAR/Vendor of Systems Long-Term/Sub Acute Care Facility/Nursing Home/Rehab Other (please specify) Home Health Care Agency
General and Financial Management Information Management cont. CEO, President, Executive Director, Administrator Other IT Personnel (please specify) CFO, Finance Director/Manager CSO/Security Officer/Director Network/MIS/Data Processing Director/Manager Planning Officer/Director Health Information Director/Manager Marketing Officer/Director Coding/DRG Director/Manager COO, VP, Assistant Administrator Systems Administrator/Analyst/Network Specialist/Project Manager CCO, Compliance Director/Manager Clinical Management CPO/Purchasing/Materials Management Director/Manager Chief of Staff/Medical Director/VP of Medical Affairs Quality Officer/Director Chief of Pathology/Pathologist Other Administrative Title (please specify) Chief of Radiology/Radiologist Other Clinical Administration (please specify) Information Management CIO, VP of Information Systems, Tech Officer Chief of Laboratory Services/Lab Administrator Chief of Medical Records/Medical Records Manager Chief of Pharmacy/Pharmacist Director/Manager of Medical Informatics Chief/VP of Nursing Services/Asst Director/Case Manager Director/Manager of Telecommunications/Call Center Director/Manager Other Title (please specify)
less than 50 1,000 - 4,999 50 - 450 5,000 - 9,999 451 - 750 10,000 - 19,999 751 - 999 20,000+
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Which of the following best describes your industry? (select only one) Select One Federal Government State & Local Government Higher Education IT K-12 Education Healthcare Corporate Accounts (500+ Employees)
Select One Federal Government State & Local Government Higher Education IT K-12 Education Healthcare Corporate Accounts (500+ Employees)
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Which of the following best describes your industry? (select only one) Agriculture Healthcare Service Provider Apparel Healthcare Banking Hospital Biotech Insurance Chemical Manufacturing Communication Media Construction Not for Profit Consulting Pharmaceutical Education Retail Electronics Shipping Energy Technology Engineering Telecommunications Entertainment Transportation Environmental Utilities Finance Other (please specify) Food and Beverage . Please select the category that best describes your title: (select only one) General and Financial Management Information Management cont. CEO, President, Executive Director, Administrator Other IT Personnel (please specify) CFO, Finance Director/Manager CSO/Security Officer/Director Network/MIS/Data Processing Director/Manager Planning Officer/Director Health Information Director/Manager Marketing Officer/Director Coding/DRG Director/Manager COO, VP, Assistant Administrator Systems Administrator/Analyst/Network Specialist/Project Manager CCO, Compliance Director/Manager Clinical Management CPO/Purchasing/Materials Management Director/Manager Chief of Staff/Medical Director/VP of Medical Affairs Quality Officer/Director Chief of Pathology/Pathologist Other Administrative Title (please specify) Chief of Radiology/Radiologist Other Clinical Administration (please specify) Information Management CIO, VP of Information Systems, Tech Officer Chief of Laboratory Services/Lab Administrator Chief of Medical Records/Medical Records Manager Chief of Pharmacy/Pharmacist Director/Manager of Medical Informatics Chief/VP of Nursing Services/Asst Director/Case Manager Director/Manager of Telecommunications/Call Center Director/Manager Other Title (please specify) What is the number of employees in your entire organization? (select only one) less than 50 1,000-4,999 50-99 5,000-9,999 100-499 10,000-19,999 500-999 20,000+
Agriculture Healthcare Service Provider Apparel Healthcare Banking Hospital Biotech Insurance Chemical Manufacturing Communication Media Construction Not for Profit Consulting Pharmaceutical Education Retail Electronics Shipping Energy Technology Engineering Telecommunications Entertainment Transportation Environmental Utilities Finance Other (please specify) Food and Beverage
less than 50 1,000-4,999 50-99 5,000-9,999 100-499 10,000-19,999 500-999 20,000+