Send Us Your Survey Content CONTACT INFORMATIONFoundation Firm Name* Primary Contact Name* First Last Email* SURVEY INFORMATIONTitle of Survey* Introduction to Survey*Please provide a simple, brief sentence in the form of a question that encompasses the nature of this survey to pose to respondents.*This question is intended to get the attention of and intrigue recipients - keep it brief, interesting, and straight-forward. How long will this survey take to complete?*Less than 3 minutes3-5 minutesMore than 5 minutesDEMOGRAPHICSWe want to help you gain the highest quality insight from your survey by selecting candidates most fitting to respond to your questions. By targeting respondents based on specific attributes you will get answers from the people whose opinions are most relevant. Select from the following targeting criteria to reach the optimal demographics for your survey. Note: CHIME will continue to send marketing communications to all of our members, however, will send additional, specific campaigns to those in alignment with your selected criteria. Areas of Expertise:* Cloud Data Management Biomedical/Clinical Engineering Data Security Electronic Health Record Financial/Administrative Systems Health Information Exchange Infrastructure All of the above Organization Services Provided:* Ambulatory Behavioral Health Clinic Home Health Care Home Insurer/Insurance Organization Hospital/Acute Care Facility Hospice Integrated Delivery System All of the above Bed Size:*Less than 100101-399400+Upload Survey Questions*Max. file size: 2 MB.
