To complete the survey electronically:

  • •  Download the appropriate physician or hospital partner form. (To the right)
  • •  Download the form by clicking on the middle icon to the top right of the screen. The file should automatically save to the Downloads folder on your computer.
  • •  Locate the file in your Downloads folder and open it in Adobe Reader. (If you don't have Adobe Reader program installed, you may download it for free here.)
  • •  Click and complete the necessary fields, then save the file to your computer. 
  • •  Attach the file in an email to Huifang Chen at

The survey may also be completed manually:

  • •  Click the appropriate physician or hospital partner form to the right.
  • •  Print the form by clicking on the print icon to the top right of the screen.
  • •  Complete the necessary fields, then fax to Huifang Chen at 917-773-8868.

Please note:

  • •  If your practice is financially strong, simply check “No,” sign and return.
  • •  If you have concerns about your practice’s financial sustainability, there are a few additional questions.
  • •  One questionnaire must be completed for each Practice ID. All information will be secure and confidential.


Downloadable Surveys




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