Let us Customize your Documents

All questions related to customization are optional, but the more you answer the more complete your documents. After purchasing we send an email with your receipt and questionnaire.

1.  Company Name:
2.  Company Address:
3.  Company Phone Number:
4.  Company Fax Number:
5.  What are your office hours and days open?
6.  Company email address.
7.  Do you have nursing available 24 hours a day?
8.  Does your company have a catch phrase?
9.  What services does your company offer?
      (Ex. Skilled Nursing, Physical Therapy, Occupational Therapy,
      Medical Social Worker, Home Health Aide, Speech Therapy, Dietician?)
10.  What is your fee schedule per discipline?
11.  What are your payor types?  e.g. Medicare, Private Pay, Medicaid,
      Insurance, Workers Compensation.
12.  What is your coverage area?
13.  Governing Body Chairperson Name:
14.  Organization List E.g. Jane Doe Administrator, John Henry Alternate Administrator, etc.
15.  Does your company utilize any consulting firms?
16.  What is your Medicare week? (Ex. Sunday to Saturday or SOC date, etc.)
17.  Name of the company you have contracted with to provide Backup Services.
     (Ex. Medical Staffing services):
18.  What is the Dress Code?
19.  We also need a copy of your logo.
20. Is your company seeking Joint Commission, ACHC, or CHAP accreditation? If so, which one?