Updated Onboarding Questionnaire New Client Onboarding Questionnaire (1) "*" indicates required fields Program OverviewFirst Name*Last Name*Bariatric Program Name*What Under Consideration Reasons do you want listed?Financial ConcernsInsurance Approval PendingLifestyle Changes RequiredNeeds More InformationSeeking Second OpinionSupport System ConcernsUndecided About SurgeryMedical/Health ConcernsLifestyle ReadinessDefault values are above. Select all that applyOther Under Consideration Reasons you would like added, or listed differently:What Lost Reasons do you want listed?BMI Outside of EligibilityDeceasedDoing MWLFinancial ConcernsHealth or Surgical Risk Too HighInsurance/Facility RestrictionsNo Longer InterestedNot Emotionally ReadyUnresponsiveDefault values are above. Select all that applyOther Lost Reasons you would like added, or listed differently:What Program Length/Pre-Op Diet selections do you want displayed in BariNav?No Diet RequiredWeight Loss Attempts6 Week3 Month4 Month6 Month12 Month12 SessionsThis field is used to calculate the Anticipated Surgery Date. Select all that applyOutreach CadenceBariNav offers the flexibility to tailor the timing of tasks and communications (emails/SMS) for both users and patients. The cadence can be customized at each stage of the patient journey to align with your program’s needs. Below, you will find a list of stages and associated activities. Please specify the number of days before each action should occur.Open/Needs to be Contacted, TaskThis stage is for patients who require outreach. The patient remains in this stage for the specified number of days before a follow-up task is created.Clinical Intake Incomplete, TaskPatients are moved to this stage if their clinical intake is incomplete. A task will be created after the specified number of days to ensure follow-up.Insurance in Process, TaskPatients in this stage are having their insurance processed. A task will be created in X days to ensure timely follow-up.Insurance in Process, Email to PatientAn email will be sent to the patient in X days to inform them that their insurance verification is still in progress.Insurance in Process, Email to SupervisorAn email will be sent to the supervisor in X days as a reminder for staff and ensure the patient continues progressing through their journey.Insurance Confirmed, TaskOnce insurance information is confirmed, the patient enters this stage. A task will be created within the specified number of days to provide benefits to patient.Insurance Confirmed, Email to SupervisorIf patient is still in this category, an email will be sent to the supervisor to ensure the patient continues progressing through their journey.No Show/Canceled, TaskIf a patient misses an appointment or cancels, they are placed in this stage. A task will be created to reschedule the visit.No Show/Canceled, Emails to PatientIf the patient remains in this category, an email will be sent in X days requesting that they reschedule.No Show/Canceled, Email to SupervisorIf the patient remains in this category, an email will be sent in X days to the supervisor.Manual Contact Attempted, TaskWhen a message has been left for the patient, they enter this stage. A task will be generated after the specified number of days to follow up again.Under Consideration, TasksPatients in this stage are considering treatment. Tasks will be generated at specified intervals to keep the process moving forward.Under Consideration, Emails to PatientPatients in this stage are considering treatment. Emails will be sent at specified intervals to re-engage the patient.Completed Pre-Op Requirements, TaskThis stage marks the completion of pre-op requirements. If the patient remains in this stage without being scheduled, tasks will be created.In Appeals, TaskPatients who are undergoing an appeal process will be moved to this stage. Tasks will be created at the specified intervals to monitor the appeal progress.In Appeals, Emails to PatientIf the patient remains in this stage, emails will be created at the specified intervals as touch-points for the patient. On Hold, TaskPatients who are on hold for any reason will be placed in this stage. Follow-up tasks are created at specified intervals to ensure the patient doesn’t become lost.On Hold, Emails to PatientIf the patient remains in this stage, email communications will be sent to re-engage the patient. Scheduled for Surgery, Emails to PatientPatients who are scheduled for surgery will be placed in this stage. Follow-up communications will be scheduled leading up to the surgery date.Completed Surgery, Email to PatientsOnce surgery is completed, the patient enters this stage. Follow-up emails will be sent at specified intervals to engage the patient post-surgery.Surgery Canceled, TaskIf surgery is canceled, patients will enter this stage. Tasks will be scheduled at specified intervals to reschedule the patient’s surgery.Surgery Canceled, Email to PatientIf the patient is still in this stage, follow-up communications will be sent at specified intervals to engage patient. What SMS templates would your program like to see?What Email templates would your program like to see?CommentsThis field is for validation purposes and should be left unchanged.
