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On-Hold Script Preparation Survey

Your name:
Clinic name:
Your address:
City/State/Zip:
Phone:
Fax:
E-mail:
Web Site:

Which package would you like? Please choose one.

2 updates per year and a Holiday program ($39 per month)
4 updates per year and a Holiday program ($59 per month)
6 updates per year and a Holiday program ($79 per month)
Purchase Superpack. (Digital equipment and 4 programs to be used within 3 years) ($975)

Office Hours: Please fill-in below.
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:

Urgent Care Hours:
Holiday Hours:

Doctors Names: Please fill-in below.

What are the primary services/specialties at your pediatric clinic? Choose all that apply.
General Medicine New Parent Education Sports Physicals Well-child Exams Childrens Dentistry Orthodontic Gynecology/Education ADHD Dermatology	Psychology Adolescent Medicine Nutritional Counseling Immunizations Allergy/Immunology Hearing Tests Eye Care Diabetes Treatment Other

What are some of the features or services at your practice that you would like to highlight, and how do they directly benefit your patients? Please fill-in below.

Have you launched any new marketing campaigns, added any specialists or new doctors, or are you promoting any new services? Please fill-in below.

Please list anything at all! (New/updated website, new telephone numbers, new locations, new employees, awards, community activities, sponsorships etc. Be creative!) Please fill-in below.

Are there special products or services you offer which your patients and their parents may not know about or forgot about? Please fill-in below.

What are some of the questions most frequently asked by your patients and their parents? Please fill-in below.

Music type preferred: Please choose one.
Smooth Jazz Classical Easy Listening	Lite Rock Country Pop

Voice talent preferred: Please choose one.
Male Female Both Alternating

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Pediatrics On Hold • P.O. Box 723 • 1865 West Wayzata Blvd. • Long Lake, MN 55356
(952) 473-2178 • (800) 811-8282