       USER RESPONSE FORM
 
       We'd like to know more about you and your requirements.
       This information helps us to make improvements, as well as
       add the new features that are most needed.  Please help
       us by completing this questionnaire and mailing it to:
       Registered users will receive  one free upgrade.
 
           Fred X. Small
           P.O. Box 57621
           Los Angeles,Ca. 90057
           USA
 
 
       USER PROFILE
 
       1.  Your computer brand and model: ___________________________
 
       2.  Amount of computer RAM memory: ___________________________
 
       3.  Printer brand and model: _________________________________
 
       4.  Are you using the codes only  1.0 version?  ___________
           If so, what network software version?  How many stations?
           __________________________________________________________
 
       5.  Compatibility problems running" Care Plans Only" on your machine?
           __________________________________________________________
 
       6.  How do you rate              (1=poor, 10=best)
           Ease of Learning _____     Ease of Use  _____
           Documentation    _____     Help screens _____
           Product Support  _____     Price        _____
 
       7.  What do you like best about Care Plans Only .
           __________________________________________________________
 
       8.  What do you like least about Care Plans Only.
           __________________________________________________________
 
       9.  Where did you hear about Care Plans Only .___________
 
       10. Where did you get this copy of Care Plans Only.__________
           Store____   Club____   Classroom____  Friend____
           Work_____   BBS___________   Bulletin board_____
           Other___________________________________________
 
       11. What application(s) do you use Care Plans Only.
           __________________________________________________________
           __________________________________________________________
           __________________________________________________________
 
       12. Do you use Care Plans Only  at home ___ office____both_____
 
       13. Your name and address (optional)
           __________________________________________________________
           __________________________________________________________
           __________________________________________________________
           __________________________________________________________
        IMPROVEMENTS WANTED
 
       Please list the improvements that you would like to
       see made to Care Plans Only   (new features, changes, etc):
 
       _________________________________________________________
       _________________________________________________________
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       What other software products do you need or plan to buy?
       _________________________________________________________
       _________________________________________________________
       _________________________________________________________
       _________________________________________________________
       _________________________________________________________
       _________________________________________________________
       END
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