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Name
EMAIL ADDRESS
TITLE
ADDRESS
CITY
STATE/ZIP CODE
PHONE NUMBER
WHO IS YOUR EMR VENDOR?
WHAT GPO DO YOU CURRENTLY USE?
HOW MANY MID LEVEL PROVIDERS (NPs/PAs) ARE AT YOUR PRACTICE?
DO YOU HAVE A DISPENSING PHARMACY? DO YOU HAVE A DISPENSING PHARMACY?YESNO
DO YOU HAVE RADIATION ONCOLOGISTS? DO YOU HAVE RADIATION ONCOLOGISTS?YESNO
DO YOU HAVE A RESEARCH PROGRAM? DO YOU HAVE A RESEARCH PROGRAM?YESNO
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