Admissions Department Needs Assessment 
Upon the completion of the questions below, your answers will be sent to The Revive Team.
Email *
How many current Admissions employees do you have?
What hours are you interested in Revive being your primary source of coverage?
Company Name *
Contact Name *
Email *
During what days/hours does your Admissions Department need coverage? *
Approximately how many calls per week are being missed? *
Do you miss calls during the times your department is staffed? *
What types of insurance does your company accept? *
What is your protocol when you receive a call and your company is unable to assist the person needing help? *
What is the approximate maximum census of your program? *
Does your program do intakes on a 24/7 basis? *
Approximately how many questions does your pre-admission assessment contain? *
What EMR system do you use? *
What CRM do you use? *
What levels of care does your program offer? *
Is your program in partnership with/does it offer sober living? *
How are your billing collections handled? *
Are there any other considerations or information The Revive Team should be aware of? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Revive Admissions.

Does this form look suspicious? Report

Google Forms