Clinic Survey

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Clinic Patient Survey
The Clinic would like to ask you to complete the following survey to help us best facilitate communication with your off island provider.

* Indicates required field

1. Does your off island physician use an Electronic Medical Record (EMR)? *

Yes No No but I would like assistance setting mine up Not sure

2. If your off island physician use an Electronic Medical Record (EMR ) please tell us the name of the system. *

Epic/”My Chart” eMD’s eClinical Works Cerner/”Health Life” Athena NextGen I don't use one I don't know Other (please specify below)

"Other" *

3. Do you use our Patient Portal? *

Yes No No but I would like assistance setting mine up Not sure

4. If you use a Patient Portal through your off island provider please tell us which one *

Athena Cerner / Health Life eClinical Works eMD’s Epic NextGen I don't know Other (Please specify below)

Other *

Comments *

Name *

Phone number (to set up your patient portal) *

Submit

280 Park Ave P.O. Box 2340 Boca Grande, FL 33921 (941) 964-0099