TASCS Quick Facts Survey for 2018

Please take a moment to complete the brief survey below using 2018 data from your center. This information is being collected to create Texas specific reports that will be used to demonstrate the value the ASC industry plays in Texas, local regions and specific legislators districts within our state. Information collected will not be identifiable (ex: salary information). This information will be made available to members.

Center Contact Information

First Name *

Last Name *

Center Name *

Center Street Address *

County *

City *

State *

Zip Code *

Phone Number *

Contact Email Address *

Center Statistics

What year did your center open for business? *

What specialties does your center specialize in? Please check all that apply. *

Number of Surgeons *

Number of Anesthesia providers *

Number of Nurses *

Total employees (Including full time, part time, contract, etc)? *

What is your total annual payroll? *

Patient Demographics

How many patients does your center care for annually? *

What percentage of your patients are the following? *

	Cash
	Private
	Medicare
	Medicaid
	Tricare
	Workers Compensation

0/100 points

What is the age range of your patients? *

Do you have a patient quote that reflects their positive experience at your center that you can share? *

Podiatry	Cardiovascular	Gastroenterology	General
Neurological	GYN	Ophthalmology	Dental
Orthopaedic	Otolaryngology	Pain	Plastic
Thoracic	Urology	Other: Other:

0-99+	0-20
18-50	40-80
Other Other