SCHEDULE YOUR ON-SITE SERVICE

We aim expertise in your direction.

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Name*

First Last

Phone*

What's your facility name?*

How many locations do you have?*

When we aim our expertise in your direction, which states do you operate in?*

Select all that apply.

Missouri

Kansas

Arkansas

Oklahoma

Nebraska

Iowa

Other

Not Applicable

What's the address of your primary location?*

Street Address City State

What's the best way for us to respond to you?*

Call

Text

Mobile phone*

Standard messaging rates apply.

Email*

Which services would you like to get underway?*

Select all that apply.

eMar/EHR Demo

In-service Education

Vaccinations (Sept, Oct, Nov)

First Aid/CPR Certification (4-10 staff)

Pharmacist Consultation

Pharmacist Inspection

Pharmacist Drug-Regimen Review

How many do you estimate will be in attendance for your eMAR/EHR Demo?*

For your eMar/EHR Demo, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your eMar/EHR Demo, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

Which day of the week will be best for your eMar/EHR Demo?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

How many do you estimate will be in attendance for your HRST Solution Demo?*

For your HRST Solution Demo, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your HRST Solution Demo, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

Which time of day will be best for your HRST Solution Demo?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

How many do you estimate will be in attendance for your In-service Education?*

For your In-service Education, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your In-service Education, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

Which time of day will be best for your In-service Education?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

How many do you estimate will be in attendance for your Vaccinations?*

For your Vaccinations, which month will be best for your service?*

Select all that apply.

September

October

November

For your Vaccinations, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

Which time of day will be best for your Vaccinations?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

For your First Aid/CPR Certification, attendance is limited to 4-10 staff. How many will be attending?*

Unknown

First Aid/CPR Certification is limited to 4-10 staff, please list names of those attending:*

Additional lines should be added for each attendee.

When do you anticipate having exact attendance numbers for First Aid/CPR Certification? We’ll reach out and connect at that time.*

For your First Aid/CPR Certification, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your First Aid/CPR Certification, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

What time of day will be best for your First Aid/CPR Certification?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

For your Pharmacist Consultation, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your Pharmacist Consultation, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

What time of day will be best for your Pharmacist Consultation?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

For your Pharmacist Inspection, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your Pharmacist Inspection, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

What time of day will be best for your Pharmacist Inspection?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

For your Pharmacist Drug-Regimen Review, which month will be best for your service?*

Select all that apply.

January

February

March

April

May

June

July

August

September

October

November

December

For your Pharmacist Drug-Regimen Review, which day of the week will be best for your service?*

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Not sure yet ... let's chat

What time of day will be best for your Pharmacist Drug-Regimen Review?*

Select all that apply.

Early morning

Late morning

Early afternoon

Late afternoon

Early evening

Not sure yet ... let's chat

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