Patient and Clinic Demographic

This form is for public health assessment use and the demographic data is the only data shared with your incoming medical scribe.

This information is not disclosed to anyone other than our internal Scribekick management team. We utilize this assessment form to gain insights internally and to best match you with your medical scribe, while offering you Scribekick training opportunities that you may be interested in having your staff participate. If you have any questions, please feel free to reach out to:
Which patient group is most important to your practice to begin assessing more routinely now?
What specific health concerns do you want to more systematically ask patients about?
Does your office have special experience, skill, expertise, and/or training in performing the following services: (Mark all that apply.)
Do you have a predominant racial or cultural demographic of your patient load?