Consultant Questionnaire

Does your client currently offer onsite health care for their employees?

No Yes

Are their health care services provided by a 3rd party vendor or managed in-house?

Third Party Direct through my company

What health care provider are they currently working with?

Why are they looking to make a switch?

What do they like about their current onsite health care services?

How many locations is your client interested in establishing an onsite health center for?

Estimate # of employees at this location:

Select this state where of this location:

Estimate # of employees at 2nd location:

Select this state where of 2nd location:

Estimate # of employees at 3rd location:

Select this state where of 3rd location:

Estimate # of employees at 4th location:

Select this state where of 4th location:

Estimate # of employees at 5th location:

Select this state where of 5th location:

Estimate # of employees at 6th location:

Select this state where of 6th location:

Estimate # of employees at 7th location:

Select this state where of 7th location:

Estimate # of employees at 8th location:

Select this state where of 8th location:

Estimate # of employees at 9th location:

Select this state where of 9th location:

Estimate # of employees at 10th location:

Select this state where of 10th location:

Does your client want the health center to provide services for eligible spouses and dependents as well?

Yes No

Select the onsite health services your client is interested in:

Select any employee wellness services your client is interested in:

Biometric Screening Wellness Coaching Fitness Nutrition Incentive Programs Wellness Portal

Why is your client interested in offering on-site health care? (select all that apply)

Better manage overall health spend Reduce member health risk Reduce absenteeism / increase presenteeism Increase employee productivity Manage chronic conditions Improve quality of care Attract and retain top talent Reduce/manage workplace injuries Other

If other, please explain:

When does your client expect to select an onsite health care vendor?

Name *

First Name Last Name

Job Title

Consultant Firm *

Phone Number *

Area Code Phone Number

Email *

example@example.com

Consultant Questionnaire

Let's talk about what QuadMed can do for your business.