Medical ProfessionWhat is your current employment status? Employed full-time Business owner Leave of Absence Military Service Unemployed Employed part-time Self employed Temporarily unemployed Homemaker Retired Disabled or permanently unemployed Student full-time Student part-time Prefer not to state Medical Profession*<Select One>Administrator/Manager/ProfessionalAthletic TrainerAudiologistChiropractorClinical Researcher/PHD/LabDentistDietician/NutritionistEstheticianEye Care ProfessionalMed Tech or ParamedicMedical DevicesMedical or Clinical StudentMental Health ProfessionalNurse – Advanced Practice (Prescriber)Nurse (Non-Prescriber)Occupational TherapistPharmacistPhysical therapistPhysician (MD, DO, Resident)Physician AssistantPodiatristPsychologistPublic Health or Social WorkerRecruiterRespiratory TherapistSpeech TherapistTherapistVeterinarian/Veterinary ProfessionalOther HealthcareOther Dental ProfessionalCompany InformationBusiness Name* Business Address* Street AddressBusiness Suite Suite (Optional)Business City* CityBusiness State*<Select One>UnknownAustralian Capitol TerritoryJervis Bay TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingStateBusiness ZIP* Zip / Postal CodeBusiness Country*<Select One>United States of AmericaCanadaMexicoAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoMyanmarBurundiCambodiaCameroonUnited States Virgin IslandsUruguayUzbekistanVanuatuVenezuelaVietnamWest Bank and Gaza StripWestern SaharaZambiaZimbabweFaroeNiuePalestineThe Cayman IslandsYemenMontenegroSerbiaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntiguaArgentinaArmeniaArubaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandThe GambiaThe Holy SeeTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Zaire)Cook IslandsCosta RicaCote d'Ivoire (Ivory Coast)CroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFederated States of MicronesiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGaza Strip and West BankGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteUnknownCountryBusiness PhoneHow many full-time employees does your practice or organization currently have?*<Select One>Sole Proprietor2-5 employees6-10 employees11-20 employees21-50 employees51-100 employees101-500 employees501-1,000 employees1,001-2,500 employees2,501-5,000 employeesMore than 5,000 employeesNot SureWhat is the approximate annual revenue of the practice or organization for which you work?*<Select One>Less than $30k$30k – less than $50k$50k – less than $100k$100k – less than $500k$500k – less than $1 Million$1 Million – less than $5 Million$5 Million – less than $10 Million$10 Million – less than $20 Million$20 Million – less than $50 Million$50 Million – less than $100 Million$100 Million – less than $200 Million$200 Million – less than $500 Million$500 Million – less than $1 BillionMore than $5 BillionNot SureHow many years have you been employed by your current firm?*<Select One>Less than 2 years2-5 years3-5 years6-10 years11+ yearsDo you supervise people?*<Select One>YesNoIn your role within your company, how many people do you supervise?*<Select One>012-34-56-1011-2021 - 5051 - 100101 - 500501 +Which of the following areas of the company for which you work do you have the authority to make purchases or influence the purchasing decisions? (Select all that apply)* Banking / Business Credit Security Computer Services / Hardware / Software Employee Benefits Employment / Tax Services Equipment Financial Services HR / Personnel Services Internet Services Legal Services Maintenance Marketing / Advertising Services Meeting Accommodations Office Services / Moving Print / Copy / Photo Services Raw Materials / Components Real Estate Services Shipping / Mail Services Telecommunications Training Travel / Transportation None of the above Do you own or rent your place of residence?*<Select One>OwnRentOtherWhat is the highest level of education you have completed?*<Select One>Less Than High SchoolHigh School GraduateSome CollegeAssociate's DegreeBachelor's DegreeSome postgraduate studyMaster's DegreeDoctorate / PhDTrade SchoolNone of the above General MedicalAre you board-certified or eligible for board certification?*<Select One>YesNoHow many years of experience do you have in your current specialty?*<Select One>Less than 1 year1-5 years6-10 years11-15 years16-20 years21-25 years26-30 years31-35 years36-40 yearsMore than 40 yearsAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Which best describes the practice or organization in which you primarily work?*<Select One>Solo office-based private practiceGroup office-based practiceManaged Care OrganizationHealth SystemLong-term Care FacilityAmbulatory Care FacilityDialysis ClinicHome CareHospiceSkilled Nursing FacilityUrgent CareMedical SpaOther type of organizationWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralIs your practice or organization privately owned, hospital-owned, part of a managed care network, or something else?*<Select One>Privately ownedHospital-ownedManaged CareSomething elseHow many beds are there at your practice or organization?*<Select One>Less than 2525 to 4950 to 99100 to 149150 to 199200 to 249250 or moreNone or Not ApplicableHave you sold a practice in the last 3 years?<Select One>YesNo PhysicianWhich of the following best describes your Specialty? Please select all that apply.* Addiction Medicine Adolescent Medicine Adult Medicine Aerospace Medicine Allergy/Immunology Allergy/Immunology - Pediatric Anesthesiology - Anesthesiologist Anesthesiology - Anesthesiologist Assistant Anesthesiology - Certified Registered Nurse Anesthetist Anesthesiology - Pediatric Anesthesiologist Audiologist Cardiology - Cardiac Electrophysiology Cardiology - Cardiac Surgery Cardiology - Cardiologist Cardiology - Interventional Cardiology Cardiology - Pediatric Cardiologist Cardiology - Peripheral Vascular Disease Counseling Critical Care (Intensivists) Critical Care (Intensivists) - Pediatric Dermatology Dietitian/Nutrition Professional Emergency Medicine Emergency Medicine - Pediatric Endocrinology Endocrinology - Pediatric Endocrinology - Reproductive Family Practice Gastroenterology Gastroenterology - Pediatric General Practice Geriatric Medicine Hematology Home Health Aide Hospice and Palliative Care Hospitalist Infectious Disease Infectious Disease - Pediatric Internal Medicine Neonatal-perinatal Medicine Nephrology Nephrology - Pediatric Neurology Neurology - Clinical Neurophysiology Neurology - Neurodevelopmental Disabilities Neurology - Neuromusculoskeletal Medicine Nuclear Medicine Obstetrics/Gynecology Occupational Medicine Oncology - Gynecological/Oncology Oncology - Hematology/Oncology Oncology - Medical Oncology Oncology - Pediatric Hematology/Oncology Ophthalmology Optometry Osteopathic Manipulative Medicine Other Otolaryngology Otolaryngology - Pediatric Pain Management Pain Management - Interventional Pain Management Pathology Pathology - Cytopathology Pathology - Forensic Pediatric Medicine Pediatric Medicine - Developmental & Behavioral Physical Medicine and Rehabilitation Physician Assistant Preventive Medicine Psychiatry Psychiatry - Addiction Psychiatry - Forensic Psychiatry - Geriatric Psychiatry Psychiatry - Neuropsychiatry Psychology - Clinical Child & Adolescent Psychologist Psychology - Clinical Neuropsychologist Psychology - Clinical Psychologist Psychology - Psychologist Psychosomatic Medicine Pulmonary Disease Pulmonary Disease - Pediatric Radiology - Diagnostic Radiology Radiology - Interventional Radiology Radiology - Neuroradiology Radiology - Nuclear Medicine Radiology - Pediatric Radiology Radiology - Radiation Oncology Radiology - Therapeutic Radiology Rehabilitation Medicine - Pediatric Rheumatology Rheumatology - Pediatric Sleep Medicine Social Worker - Licensed Clinical Social Worker Sports Medicine Surgery - Colorectal Surgery (formerly proctology) Surgery - Foot and Ankle Surgery - General Surgery Surgery - Hand Surgery Surgery - Head and Neck Surgery - Maxillofacial Surgery Surgery - Nuerosurgery Surgery - Oral and Maxillofacial Surgery Surgery - Oral Surgery (dentists only) Surgery - Orthopedic Spine Surgery Surgery - Orthopedic Surgery Surgery - Otolaryngology/Facial Plastic Surgery Surgery - Pediatric Orthopedic Surgery Surgery - Pediatric Surgery Surgery - Plastic and Reconstructive Surgery Surgery- Surgical Oncology Surgery - Thoracic Surgery Surgery - Trauma Surgery - Vascular Surgery - Vascular Surgery Therapy - Message Therapist Therapy - Occupational Therapist Therapy - Physical Therapist Therapy - Speech Language Pathologist Urology Urology - Pediatric Orthopedics How many years of experience do you have in your current specialty?*<Select One>Less than 1 year1-5 years6-10 years11-15 years16-20 years21-25 years26-30 years31-35 years36-40 yearsMore than 40 yearsAre you board-certified or eligible for board certification?*<Select One>YesNoWhat is your NPI number? As part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Which best describes the practice or organization in which you primarily work?*<Select One>Solo office-based private practiceGroup office-based practiceManaged Care OrganizationHealth SystemLong-term Care FacilityAmbulatory Care FacilityDialysis ClinicHome CareHospiceSkilled Nursing FacilityUrgent CareMedical SpaOther type of organizationWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralIs your practice or organization privately owned, hospital-owned, part of a managed care network, or something else?*<Select One>Privately ownedHospital-ownedManaged CareSomething elseHow many beds are there at your practice or organization?*<Select One>Less than 2525 to 4950 to 99100 to 149150 to 199200 to 249250 or moreNone or Not ApplicableHave you sold a practice in the last 3 years?*<Select One>YesNo NursingWhich of the following credentials do you possess? Please select all that apply.* Registered Nurse (RN) Licensed Practical Nurse (LPN) Advanced Practice Registered Nurse (APRN) Nurse Practitioner (NP) Clinical Nurse Specialist (CNS) Nurse Manager Patient Coordinator None of the above Which of the following best describes your Specialty? Please select all that apply.* Addiction Medicine Adolescent Medicine Adult Medicine Aerospace Medicine Allergy/Immunology Allergy/Immunology - Pediatric Anesthesiology - Anesthesiologist Anesthesiology - Anesthesiologist Assistant Anesthesiology - Certified Registered Nurse Anesthetist Anesthesiology - Pediatric Anesthesiologist Audiologist Cardiology - Cardiac Electrophysiology Cardiology - Cardiac Surgery Cardiology - Cardiologist Cardiology - Interventional Cardiology Cardiology - Pediatric Cardiologist Cardiology - Peripheral Vascular Disease Counseling Critical Care (Intensivists) Critical Care (Intensivists) - Pediatric Dermatology Dietitian/Nutrition Professional Emergency Medicine Emergency Medicine - Pediatric Endocrinology Endocrinology - Pediatric Endocrinology - Reproductive Family Practice Gastroenterology Gastroenterology - Pediatric General Practice Geriatric Medicine Hematology Home Health Aide Hospice and Palliative Care Hospitalist Infectious Disease Infectious Disease - Pediatric Internal Medicine Neonatal-perinatal Medicine Nephrology Nephrology - Pediatric Neurology Neurology - Clinical Neurophysiology Neurology - Neurodevelopmental Disabilities Neurology - Neuromusculoskeletal Medicine Nuclear Medicine Nurse - Certified Clinical Nurse Specialist Nurse - Certified Nurse Midwife Nurse - Nurse Practitioner Obstetrics/Gynecology Occupational Medicine Oncology - Gynecological/Oncology Oncology - Hematology/Oncology Oncology - Medical Oncology Oncology - Pediatric Hematology/Oncology Ophthalmology Optometry Osteopathic Manipulative Medicine Other Otolaryngology Otolaryngology - Pediatric Pain Management Pain Management - Interventional Pain Management Pathology Pathology - Cytopathology Pathology - Forensic Pediatric Medicine Pediatric Medicine - Developmental & Behavioral Physical Medicine and Rehabilitation Physician Assistant Preventive Medicine Psychiatry Psychiatry - Addiction Psychiatry - Forensic Psychiatry - Geriatric Psychiatry Psychiatry - Neuropsychiatry Psychology - Clinical Child & Adolescent Psychologist Psychology - Clinical Neuropsychologist Psychology - Clinical Psychologist Psychology - Psychologist Psychosomatic Medicine Pulmonary Disease Pulmonary Disease - Pediatric Radiology - Diagnostic Radiology Radiology - Interventional Radiology Radiology - Neuroradiology Radiology - Nuclear Medicine Radiology - Pediatric Radiology Radiology - Radiation Oncology Radiology - Therapeutic Radiology Rehabilitation Medicine - Pediatric Rheumatology Rheumatology - Pediatric Sleep Medicine Social Worker - Licensed Clinical Social Worker Sports Medicine Surgery - Colorectal Surgery (formerly proctology) Surgery - Foot and Ankle Surgery - General Surgery Surgery - Hand Surgery Surgery - Head and Neck Surgery - Maxillofacial Surgery Surgery - Neurosurgery Surgery - Oral and Maxillofacial Surgery Surgery - Oral Surgery (dentists only) Surgery - Orthopedic Spine Surgery Surgery - Orthopedic Surgery Surgery - Otolaryngology/Facial Plastic Surgery Surgery - Pediatric Orthopedic Surgery Surgery - Pediatric Surgery Surgery - Plastic and Reconstructive Surgery Surgery- Surgical Oncology Surgery - Thoracic Surgery Surgery - Trauma Surgery - Vascular Surgery - Vascular Surgery Therapy - Message Therapist Therapy - Occupational Therapist Therapy - Physical Therapist Therapy - Speech Language Pathologist Urology Urology - Pediatric How many years of experience do you have in your current specialty?*<Select One>Less than 1 year1-5 years6-10 years11-15 years16-20 years21-25 years26-30 years31-35 years36-40 yearsMore than 40 yearsAre you board-certified or eligible for board certification?*<Select One>YesNoAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Which best describes the practice or organization in which you primarily work?*<Select One>Solo office-based private practiceGroup office-based practiceManaged Care OrganizationHealth SystemLong-term Care FacilityAmbulatory Care FacilityDialysis ClinicHome CareHospiceSkilled Nursing FacilityUrgent CareMedical SpaOther type of organizationWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralIs your practice or organization privately owned, hospital-owned, part of a managed care network, or something else?*<Select One>Privately ownedHospital-ownedManaged CareSomething elseHow many beds are there at your practice or organization?*<Select One>Less than 2525 to 4950 to 99100 to 149150 to 199200 to 249250 or moreNone or Not Applicable DentalWhat best describes your role?*<Select One>DentistDental HygienistOrthodontistTechnicianPractice ManagerWhat is your primary specialty?*<Select One>EndodonticsOral & Maxillofacial SurgeryOral Medicine & PathologyOral & Maxillofacial RadiologyOrthodontics & Dentofacial OrthopedicsPediatric DentistryGeneral DentistryPeriodonticsProsthodonticsWhat best describes the dental practice you work at?*<Select One>Independently ownedPractice is part of a national chainPractice is part of a regional chainOtherWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Have you sold a practice in the last 3 years?*<Select One>YesNo PharmacyWhat best describes your role?*<Select One>PharmacistSenior PharmacistHead of PharmacyPharmacy TechnicianPharmacy ConsultantWhich of the following do you specialize in? Please select all that apply.* Oncology pharmacy Nuclear pharmacy Geriatric pharmacy Psychopharmacotherapy Personal pharmacy Nutritional support pharmacy Hospice pharmacy Pediatric pharmacy Pharmacy benefit manager Poison control pharmacy What best describes the pharmacy or organization you work at?*<Select One>Retail/Community Pharmacy ChainIndependently Owned Retail/Community PharmacyHospital PharmacySpecialty PharmacyClinical PharmacyAmbulatory Care PharmacyHome Care PharmacyConsulting PharmacyCompounding PharmacyWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Have you sold a practice in the last 3 years?*<Select One>YesNo VeterinaryWhich of the following best describes your role at work?*<Select One>General Practitioner Veterinarian (GP)Veterinary Specialist (e.g., neurology, oncology, ophthalmology, etc.)Veterinary AssistantVeterinary TechnicianOffice Manager/Practice ManagerWhich of the following best describes the primary patient focus of the practice or organization you work at? Please select all that apply.* Small animal exclusive Mobile practice Emergency practice Equine practice Large animal practice Military or government Specialty practice Feline exclusive Food animal Teaching or research None of the above What best describes the veterinary practice you work at?*<Select One>Independently ownedPractice is part of a national chainPractice is part of a regional chainOtherWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Have you sold a practice in the last 3 years?*<Select One>YesNo AdministrativeWhich of the following best describes your job title?*<Select One>Administrative/Human Resources – Administrative AssistantAdministrative/Human Resources – Billing OfficerAdministrative/Human Resources – Chief Human Resources OfficerAdministrative/Human Resources – Education OfficerAdministrative/Human Resources – HR AdministratorAdministrative/Human Resources – Human Resources DirectorAdministrative/Human Resources – Human Resources ManagerAdministrative/Human Resources – Physician RecruiterAdministrative/Human Resources – Recruiter (Other)Administrative/Human Resources – Vice President of Human ResourcesBoard of Directors/Trustees – Board MemberBoard of Directors/Trustees - ChairmanBoard of Directors/Trustees - CommissionerBoard of Directors/Trustees - DirectorBoard of Directors/Trustees – SecretaryBoard of Directors/Trustees – TreasurerBoard of Directors/Trustees – TrusteeBoard of Directors/Trustees – Vice President of the BoardChief Executive/President/Administrator – Chief Executive OfficerChief Executive/President/Administrator – Executive AdministratorChief Executive/President/Administrator – Executive DirectorChief Executive/President/Administrator – Executive PartnerChief Executive/President/Administrator – Executive Vice PresidentChief Executive/President/Administrator – OwnerChief Executive/President/Administrator – Practice AdministratorChief Executive/President/Administrator – PresidentFinance/Accounting – AccountantFinance/Accounting – Business ManagerFinance/Accounting – Chief Financial OfficerFinance/Accounting – ControllerFinance/Accounting – Director of FinanceFinance/Accounting – Patient Accounts ExecutiveFinance/Accounting – Patient Financial Services ExecutiveFinance/Accounting – Revenue Cycle ExecutiveFinance/Accounting – Vice President of FinanceInformation Technology – Chief Information OfficerInformation Technology – Chief Medical Information OfficerInformation Technology – Coding ManagerInformation Technology – Director of ITInformation Technology – HIM ExecutiveInformation Technology – Vice President of ITLegal/Regulatory/Compliance – Chief Compliance OfficerLegal/Regulatory/Compliance – Chief Legal OfficerLegal/Regulatory/Compliance – Compliance OfficerLegal/Regulatory/Compliance – General CounselLegal/Regulatory/Compliance – Risk Management OfficerMedical/Quality/Care Management – Case ManagementMedical/Quality/Care Management – Chief Medical OfficerMedical/Quality/Care Management – Chief of StaffMedical/Quality/Care Management – Chief Quality OfficerMedical/Quality/Care Management – Director of AnesthesiologyMedical/Quality/Care Management – Director of CardiologyMedical/Quality/Care Management – Director of ICUMedical/Quality/Care Management – Director of OncologyMedical/Quality/Care Management – Director of OrthopedicsMedical/Quality/Care Management – Director of RehabilitationMedical/Quality/Care Management – Director of Respiratory TherapyMedical/Quality/Care Management – Director of Sterile ProcessingMedical/Quality/Care Management – Director of Wound CareMedical/Quality/Care Management – Emergency Department DirectorMedical/Quality/Care Management – Infection PreventionMedical/Quality/Care Management – Medical DirectorMedical/Quality/Care Management – Nutritional ServicesMedical/Quality/Care Management – Operating Room OfficerMedical/Quality/Care Management – Patient Access OfficerMedical/Quality/Care Management – Physician in ChiefMedical/Quality/Care Management – Physician Leader-LiaisonMedical/Quality/Care Management – Quality OfficerMedical/Quality/Care Management – Vice President of Medical AffairsNursing Executive – Chief Nursing OfficerNursing Executive – Director of NursingNursing Executive – Director of Patient CareNursing Executive – Nurse ManagerNursing Executive – Vice President of NursingNursing Executive – Vice President of Patient CareOperations – Business OfficerOperations – Chief Operating OfficerOperations – Contracting ExecutiveOperations – Director of FacilitiesOperations – Director of OperationsOperations – Environmental Services OfficerOperations – Vice President of OperationsPharmacy – Chief Pharmacy OfficerPharmacy – Director of PharmacyPharmacy – Pharmacy ManagerPharmacy – Vice President of PharmacyPurchasing/Materials/Supply – Director of Materials ManagementPurchasing/Materials/Supply – Director of PurchasingPurchasing/Materials/Supply – Director of Supply ChainPurchasing/Materials/Supply – Purchasing ManagerPurchasing/Materials/Supply – Vice President of PurchasingRadiology – Chief of RadiologyRadiology – Director of ImagingRadiology – Director of RadiologyRadiology – Radiology ManagerSales/Marketing/Business Development – Chief Development OfficerSales/Marketing/Business Development – Chief Marketing OfficerSales/Marketing/Business Development – Chief Strategy OfficerSales/Marketing/Business Development – Director of Business DevelopmentSales/Marketing/Business Development – Director of MarketingSales/Marketing/Business Development – Marketing ManagerSales/Marketing/Business Development – Vice President of Sales-Marketing-Business DevelopmentWomen’s Health/OBGYN – Director of Labor and DeliveryWomen’s Health/OBGYN – Director of MaternityWomen’s Health/OBGYN – Director of ObstetricsWomen’s Health/OBGYN – Director of Women’s HealthWomen’s Health/OBGYN – Vice President of Women’s HealthAre you board-certified or eligible for board certification?*<Select One>YesNoHow many years of experience do you have in your current specialty?*<Select One>Less than 1 year1-5 years6-10 years11-15 years16-20 years21-25 years26-30 years31-35 years36-40 yearsMore than 40 yearsWhich best describes the practice or organization in which you primarily work?*<Select One>Solo office-based private practiceGroup office-based practiceManaged Care OrganizationHealth SystemLong-term Care FacilityAmbulatory Care FacilityDialysis ClinicHome CareHospiceSkilled Nursing FacilityUrgent CareMedical SpaOther type of organizationWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralIs your practice or organization privately owned, hospital-owned, part of a managed care network, or something else?*<Select One>Privately ownedHospital-ownedManaged CareSomething elseHow many beds are there at your practice or organization?*<Select One>Less than 2525 to 4950 to 99100 to 149150 to 199200 to 249250 or moreNone or Not ApplicableAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Clinical ResearchWhich of the following best describes your specialty?*<Select One>Advanced Health DegreeBiochemistryClinical OfficerClinical ResearchFaculty/ResearchLab ManagerLab ScientistMicrobiologyPathologyAre you board-certified or eligible for board certification?*<Select One>YesNoHow many years of experience do you have in your current specialty?*<Select One>Less than 1 year1-5 years6-10 years11-15 years16-20 years21-25 years26-30 years31-35 years36-40 yearsMore than 40 yearsWhich best describes the practice or organization in which you primarily work?*<Select One>Solo office-based private practiceGroup office-based practiceManaged Care OrganizationHealth SystemLong-term Care FacilityAmbulatory Care FacilityDialysis ClinicHome CareHospiceSkilled Nursing FacilityUrgent CareMedical SpaOther type of organizationWhich of the following best describes the area in which your primary practice or organization is located?*<Select One>UrbanSuburbanRuralIs your practice or organization privately owned, hospital-owned, part of a managed care network, or something else?*<Select One>Privately ownedHospital-ownedManaged CareSomething elseHow many beds are there at your practice or organization?*<Select One>Less than 2525 to 4950 to 99100 to 149150 to 199200 to 249250 or moreNone or Not ApplicableAs part of your current role, are you involved in selecting any of the following vendors? Please select all that apply. * Medical supplies provider Janitorial services provider Catering services provider Pharmacy provider Employee benefits provider (non-insurance) Software/information technology provider Insurance provider None of the above Medical StudentWhat year did you enroll in Medical School?*<Select One>202020192018201720162015201420132012201120102009200820072006200520042003200220012000What specialty do you expect to earn?*<Select One>Addiction MedicineAdolescent MedicineAdult MedicineAerospace MedicineAllergy/ImmunologyAllergy/Immunology - PediatricAnesthesiology - AnesthesiologistAnesthesiology - Anesthesiologist AssistantAnesthesiology - Certified Registered Nurse AnesthetistAnesthesiology - Pediatric AnesthesiologistAudiologistCardiology - Cardiac ElectrophysiologyCardiology - Cardiac SurgeryCardiology - CardiologistCardiology - Interventional CardiologyCardiology - Pediatric CardiologistCardiology - Peripheral Vascular DiseaseCounselingCritical Care (Intensivists)Critical Care (Intensivists) - PediatricDermatologyDietitian/Nutrition ProfessionalEmergency MedicineEmergency Medicine - PediatricEndocrinologyEndocrinology - PediatricEndocrinology - ReproductiveFamily PracticeGastroenterologyGastroenterology - PediatricGeneral PracticeGeriatric MedicineHematologyHome Health AideHospice and Palliative CareHospitalistInfectious DiseaseInfectious Disease - PediatricInternal MedicineNeonatal-perinatal MedicineNephrologyNephrology - PediatricNeurologyNeurology - Clinical NeurophysiologyNeurology - Neurodevelopmental DisabilitiesNeurology - Neuromusculoskeletal MedicineNuclear MedicineObstetrics/GynecologyOccupational MedicineOncology - Gynecological/OncologyOncology - Hematology/OncologyOncology - Medical OncologyOncology - Pediatric Hematology/OncologyOphthalmologyOptometryOsteopathic Manipulative MedicineOtherOtolaryngologyOtolaryngology - PediatricPain ManagementPain Management - Interventional Pain ManagementPathologyPathology - CytopathologyPathology - ForensicPediatric MedicinePediatric Medicine - Developmental & BehavioralPhysical Medicine and RehabilitationPhysician AssistantPreventive MedicinePsychiatryPsychiatry - AddictionPsychiatry - ForensicPsychiatry - Geriatric PsychiatryPsychiatry - NeuropsychiatryPsychology - Clinical Child & Adolescent PsychologistPsychology - Clinical NeuropsychologistPsychology - Clinical PsychologistPsychology - PsychologistPsychosomatic MedicinePulmonary DiseasePulmonary Disease - PediatricRadiology - Diagnostic RadiologyRadiology - Interventional RadiologyRadiology - NeuroradiologyRadiology - Nuclear MedicineRadiology - Pediatric RadiologyRadiology - Radiation OncologyRadiology - Therapeutic RadiologyRehabilitation Medicine - PediatricRheumatologyRheumatology - PediatricSleep MedicineSocial Worker - Licensed Clinical Social WorkerSports MedicineSurgery - Colorectal Surgery (formerly proctology)Surgery - Foot and AnkleSurgery - General SurgerySurgery - Hand SurgerySurgery - Head and NeckSurgery - Maxillofacial SurgerySurgery - NuerosurgerySurgery - Oral and Maxillofacial SurgerySurgery - Oral Surgery (dentists only)Surgery - Orthopedic Spine SurgerySurgery - Orthopedic SurgerySurgery - Otolaryngology/Facial Plastic SurgerySurgery - Pediatric Orthopedic SurgerySurgery - Pediatric SurgerySurgery - Plastic and Reconstructive SurgerySurgery- Surgical OncologySurgery - Thoracic SurgerySurgery - TraumaSurgery - VascularSurgery - Vascular SurgeryTherapy - Message TherapistTherapy - Occupational TherapistTherapy - Physical TherapistTherapy - Speech Language PathologistUrologyUrology - PediatricWhat is the name of your school?* AudiologistHave you sold a practice in the last 3 years?<Select One>YesNo ChiropractorHave you sold a practice in the last 3 years?<Select One>YesNo Eye Care ProfessionalsWhich of the following best describes your role?<Select One>OptometristOphthalmologistEye Care TechnicianOpticianWhich of the following best describes how you currently practice?<Select One>At a single private practice I own or co-ownAt a chain of private practices I own or co-ownAt a single private practice owned by another doctorAt a chain of private practices owned by another doctorAt a retail chain (e.g., Pearl Vision, LensCrafters, EyeCare Partners, etc.)At a hospital or research institutionHave you sold a practice in the last 3 years?<Select One>YesNo Mental HealthHave you sold a practice in the last 3 years?<Select One>YesNo PodiatristHave you sold a practice in the last 3 years?<Select One>YesNo Δ
