What type of clinic do you operate? (Select one)
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Primary Care Clinic
Urgent Care Center
Home Health Agency
Nursing Home
Hospital
Podiatry Clinic
Orthopedic Clinic
Other
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Please specify clinic/facility name
How many wound care patients do you typically see per month?
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0-10
11-25
26-50
51-100
100+
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Are you currently offering wound care services? (Select one)
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Yes, we have an existing wound care program
No, we are looking to add wound care services
No, but we refer out to other wound care providers
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Who makes purchasing decisions for wound care products in your clinic? (Select all that apply)
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Medical Director
Director of Nursing
Office Manager
Nurse Practitioner
Other
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What is your biggest challenge with your current wound care provider? (Select one)
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High costs
Limited product selection
Slow delivery times
Poor customer service
Lack of training or support
We do not currently use a wound care supplier
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Are you currently under contract with a wound care product supplier?
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Yes
No
Unsure
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Would you be open to a consultation to see how we can improve your wound care services?
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Yes, I’d like to learn more
No, I’m happy with my current setup
Maybe, I need more details
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How do you currently order wound care products? (Select one)
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Through a distributor
Direct from manufacturers
Through a GPO (Group Purchasing Organization)
We don’t have a set process yet
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How soon are you looking to upgrade your wound care products or services?
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Immediately
Within the next 30 days
Within the next 3 months
Not sure yet
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Full Name
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Clinic Name
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Phone
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Email
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Preferred Contact Method
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Phone Call
Email
Text Message
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