Pass My Physical Survey

Your Name*

First Last

Your Email*

1. Do you currently use EHR for your DOT exams?*

2. IF you use EHR for DOT exams, do you like your current system?*

3. What features are important to you (pick as many as appropriate)?*

3. OTHER: Please describe

4. If you would like to add to your system, what features would you like to add (pick as many features as you like)?*

4. OTHER: Please describe

5. If you would like to add to your system, what features would you like to add (pick as many features as you like)?*

5. OTHER: Please describe

6. Membership Benefits: Please choose membership benefits you would like to see

6. Membership Benefits: OTHER: Please describe