Application Questions(For some of the survey questions, you might need to run a report from your EHR) Practice Information Practice Name * Practitioner Name * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * How many providers are in your practice? * What is the number of active patients with diabetes in your practice currently? * *ModMed customers can view the Doctor Direct video titled Leap Vitals Documentation for instructions on how to find your current count of patients with diabetes. What instrument/tools do you use to assess dry skin? * Do you routinely assess for ‘hot spots’ as part of your skin assessment? * Yes No If yes, what instrument/tools are you using? If yes, how do you compare that finding visit to visit? What EHR does your practice use * As a participant of this study you will be required to complete 2 short survey questionnaires - the first at 4 weeks (half way through) and the second at the 6 week mark. Please indicate your willingness to complete both surveys via email/website link: * Yes No By clicking the button below, you agree to the study's terms. These tools are loaned to you, and if you do not use them, you will be asked to return them. * I agree Thank you!
