Forms Questionnaire 2022 - Procentive Customer Success

Name*

First Last

Organization Name*

Email Address*

Are you a new agency?*

Are you credentialed/contracted with Payers?*

If yes, which Payers?

Have you used an EHR before?*

If Yes, Indicate the EHR vendor:

If No, are you converting from paper?

How many different forms do you typically use with a client?*

Do you like your current forms?*

When was the last time your forms were audited?*

What types of services do you provide?

Other:*

What is your agency licensed for?

Other:*

What assessments do you use?*

*Copyright and licensing fees may apply

Other:*

Do you submit any client data to your state?

Other:*

Which forms would you like to review in Procentive if they are available?

You could include DAANES forms, Release of Information, etc.

Do you collect information in your intake paperwork that would be helpful to have automatically appear in your initial Assessment for your clients?

Who does your Clinical staff include?

This would include anyone who would be filling out paperwork to keep in a client's chart

Please explain when a staff person would need to review and sign off on another staff person's forms.

Is there anything else you would like to tell us about your form needs?

Forms Consultation