Synertx

Your Name * Title First Last Suffix
Your Title

Your title at the facility
Company or Facility Name *

The facility name, or the name of the company that owns the facility
Facility Type
Facility Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone ### - ### - ####
Please enter the best phone number to reach you on during business hours
Best Time to Call HH : MM : SS AM/PM
Email
Number of Nursing Beds
Current Total Census
Average Daily Med A Census
Average Number of Skilled/Manged Care Patients
Current Therapy Staff
(# of FTE by Position)

Example; 1 full time PT, 2 part time PTAs, 1 part time OT
Current Rate Structure
(How you pay your rehab vendor for each payor type)
What are your primary issues with the current provider?

Staffing? Rates? Customer Service? Let us know about any problems with your current provider so we can address them when we call
When do you plan on changing rehab providers?
Do Not Fill This Out