PROSPECTIVE SOLUTION PROVIDER INFO:

Company Name:

First Name:

Last Name:

Title:

Website:

Email:

Phone:

Mobile:

Street Address:

City:

State:



How do you best describe your company?


How do you best describe your product/service offering?


Briefly describe marketing efforts for your company’s product/service offering.


What are your distinct advantages over your competition?


In what states are your products/services available?


What medical specialties do your target with your product/service?


Within your targeted specialties, what are the key characteristics of an ideal prospect? Please include ideal size of practice and payor mix.


How many practices do you currently service?


What is the ownership structure of your company?


What is your top tier compensation structure?



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