Welcome to our Practice Profitability Assessment.

This evaluation is designed to estimate how much you could save by using the Kaizen Systems service. Please note that these are estimated numbers based on averages calculated as set forth below.

Simply fill out the form below and you will immediatly receive the results of the evaluation:

* Required
Salutation:
First Name:	*
Last Name:	*
Company Name:
Title:
Address 1:	*
Address 2:
City:	*
State:	*
Zip:	*
Telephone:	*
Fax:
E-mail:	*

I'd like to be sent more information via email from Kaizen Systems.
		Yes
		No

How many physicians are in your group practice?
		1-3
		4-9
		10-24
		25-100
		100+

What practice management system are you currently using?
		Medic
		IDX
		Medical Manager
		Millbrook
		Compusense
		None
		Other

Does your group use an outsourced billing service ?
		Yes
		No

Who makes the practice workflow (scheduling, registration, eligibility checking, referral tracking) and billing process decisions in your group?
	Practice Name:
	Address 1:
	Address 2:
	City:
	State:
	Zip Code:
	Contact Name:
	Phone:

When did you implement your current practice management and billing system or service ?
		Within the past 12 months
		1-2 years
		3-5 years
		over 5 years

Would you consider an alternative practice workflow and claims management solution that increases your net collections by up to 10%, improves your cash flow by 30% and reduces your overall cost of billing?
		Yes
		No
Are you currently speaking to an Kaizen Systems sales representative? *
		Yes
		No
Please provide the name of the representative you are speaking with.

In order to complete your practice profitability assesment please answer the following questions about your practice:

Annual Collections:
Number of Physicians:
Average DSO:
Average Revenue Per Visit:
Patients Seen Per Week:
Non-Reimbursable Patients Per Week*:

* Patients seen that you do not receive payment for because of reasons such as insurance ineligibility.

Kaizen Systems, Inc. only gathers personally identifiable data (such as names and addresses) when voluntarily submitted by a visitor. Any and all information collected by Kaizen Systems, Inc. is used for internal business purposes only. Kaizen Systems, Inc. will at no time allow collected information to be sold, traded, or otherwise viewed by any third parties. Only visitors requesting email from Kaizen Systems, Inc. will receive email.