---
# src/pages/diagnostic.astro
# Drop this file into your Astro project at: src/pages/diagnostic.astro
# It will be available at: form.otlen.com (or otlen.com/diagnostic if no subdomain)
#
# SETUP:
# 1. Replace YOUR_EMAIL@otlen.com below with the email you want submissions sent to
# 2. Drop this file into src/pages/
# 3. Deploy
# 4. FormSubmit.co will send a confirmation email on first submission - click to activate
#
# FORMSUBMIT.CO CONFIG (same service you use for /contact and /demo):
# - Submissions emailed to you
# - No account needed
# - Spam filtered automatically
# - You can add _cc, _subject, _template etc. via hidden fields below
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Revenue System Diagnostic | OTLEN
This short assessment captures the key data points we need to identify where revenue is leaking in your facility. Takes about 5 minutes. All information is strictly confidential.
All responses are encrypted and used solely for your diagnostic report.
What happens next
1
You complete this form
~5 minutes. Approximate figures are fine.
2
We analyze your data
Our team maps revenue flow gaps specific to your facility.
3
Revenue Gap Summary delivered
Within 48 hours. No meetings required unless you want one.
01/ Facility Profile
Tell us about your facility
Basic information to contextualize your diagnostic report.
Please enter your facility name
Please enter a valid email address
02/ Service Mix
What services does your facility offer?
Select all that apply.
Clinical Laboratory
Hematology
Blood Chemistry
Serology / Immunology
Urinalysis / Fecalysis
Drug Testing
Pre-Employment Screening
X-Ray
Ultrasound
ECG
Corporate APE
OFW Medical
PhilHealth-Accredited
HMO-Accredited
Home Service / Mobile
03/ Revenue Flow
How does money flow through your facility?
Approximate figures work perfectly.
04/ Systems & Technology
What tools run your operations?
Understanding your tech stack helps identify integration gaps.
Walk-in
Phone / SMS
Messenger
Viber / WhatsApp
Website
Online booking
Email
05/ Operational Gaps
Where do you feel the friction?
Rate how much each area impacts your revenue.
Patients lost between inquiry and booking
Not an issue
Minor
Moderate
Significant
Delays in releasing test results
Not an issue
Minor
Moderate
Significant
Billing errors or missed charges
Not an issue
Minor
Moderate
Significant
Insurance claim delays or denials
Not an issue
Minor
Moderate
Significant
Uncollected corporate receivables
Not an issue
Minor
Moderate
Significant
Staff time wasted on manual data entry
Not an issue
Minor
Moderate
Significant
No visibility into daily/weekly revenue
Not an issue
Minor
Moderate
Significant
Low patient return / follow-up rates
Not an issue
Minor
Moderate
Significant
06/ Final Context
Anything else we should know?
These help us tailor your report to your actual situation.
Diagnostic Submitted
Your Revenue Gap Summary will be delivered within 48 hours. No meetings required - the report speaks for itself.