Please fill out this quick 15 question survey as accurately and completely as possible.
This survey allows us to make sure Access 2 Integration is a good fit for you, your patients, and for us.
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The purpose of this survey is to make sure you and Access 2 Integration (A2I) are a good fit, and we thank you in advance for your time.

 
What is your full name? *

 
What is your cell phone number? *

This number will only be used to contact you regarding your survey.
 
What is your email address? *

This email address will only be used to contact you about your survey.
 
What is the city, state, and zip code in which your practice is located? We use this information to see if your area is available for integration with A2I. *

 
How many patients do you see per week? *

 
How many new patients per month do you see? *

 
Which services that A2I offers are you most interested in implementing? *







 
If you don't add more revenue to your practice what will that mean for you in the next 5 to 10 years? *

 
Do you have the financial resources on hand or a line of credit to pay for the A2I program and the initial start up expenses? *

We want to make sure that you are financially prepared before working with us.  Financing options are available if you need them.
 
Do you need information about financing recommendations? *

 
Do you have additional questions that you'd like to ask or discuss when we speak with you? *

 
Are you willing to hold an education talk at least once a week? *

     
 
Are you willing to invest at least $2,500 per month to market your Regen Med services? *

     
 
Did someone refer you to A2I?

 
Please list their full name/names.

 
Thank you for filling out the survey.  We will be in touch very soon to schedule a time to talk with you.  If you have urgent question and need to speak to someone sooner, please call us at (317) 527-1113.

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