Consultant Questionnaire

Consultant Questionairre
Does your client currently offer onsite health care services to 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 your current onsite health care services?
How many locations would your client like to offer onsite health services 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:
Would they like to include dependents as users of the onsite health services?

Yes No
Select the on-site health services your client is interested in:

Primary Care Occupational Health Wellness Programs
Additional Services they would like to find out more information about:

Telemedicine / Telehealth Chronic Condition Management Behavioral Health Health Screenings Physical Therapy Lab / Testing Pharmacy Radiology Dental Vision Biometric Screening Wellness Coaching Incentive Programs Nutrition Wellness Portal Fitness
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 Quality and/or consistency leadership image Attract and retain top talent Reduce/manage workplace injuries Other
If other, please explain:
What time frame are they expecting to make a decision about selecting an onsite health care vendor?
Name

First Name Last Name
Job Title
Consultant Firm
Phone Number

Area Code Phone Number
Email
example@example.com
Should be Empty:

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Consultant Questionairre

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