Business Associate HIPAA Risk Analysis™ Quotation Request

Thank you for taking the time to fill out this brief survey regarding your business. It will help us make an accurate pricing estimate with the minimal amount of time required by you.

1. What is your business's legal name? *This question is required.

2. What is your name? *This question is required.

3. What is your position / title? *This question is required.

4. What is your phone number (in ###-###-#### format)? *This question is required.

5. What is your business email address? *This question is required. This question requires a valid email address.

8. Are any of your physical locations embedded in a larger organization, such as inside a hospital? *This question is required.

9. Do you use Cloud-based (hosted on the Internet) applications to access or store your customer's Electronic Protected Healthcare Information? *This question is required.

10. What is the name of the vendor(s) of the primary application(s) used to access or store your customer's Electronic Protected Healthcare Information? *This question is required.

11. Were any of the applications you use to access or store your customer's Electronic Protected Healthcare Information custom developed by your staff or a 3rd party consultant? *This question is required.

Business Associate HIPAA Risk Analysis™ Quotation Request

Welcome