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Exit Survey
 
 
intro intro
 
 
Contact Information
* First Name : 
* Last Name : 
* Name of Practice or Employer : 
   License # : 
* City : 
* State : 
* Zip : 
* Phone (cell preferred) : 
* Email Address : 
* Country : 
 
 
 
* What type of the following Medical Professionals most closely describe you?
 
Alternative Medical Practitioner
 
Chiropractor
 
Dentistry
 
Eye Care Professional
 
Mental Health Professional
 
Nurse
 
Nurse Practitioner
 
Other Nursing Professional (CNA, HH Aide, LPN/Vocational)
 
Physician
 
Physician Assistant
 
Other Medical Professional (Execs, Payors, Techs, Admin, Other)
 
Veterinarian
 
Student
 
 
 
* Which best describes your Alternative Medical Pracitioner profile?
 
Acupuncture
 
Anti-Aging Medicine
 
Ayurvedic medicine
 
Herbalist
 
Holistic Dietetics/Nutrition
 
Homeopathic Medicine
 
Hypnotherapist
 
Integrative Medicine
 
Medical Massage Therapy
 
Midwifery/Doula
 
Naturopathic Medicine
 
Reiki Practitioner
 
Traditional Chinese Medicine
 
Other
 
 
 
 
* Which Chiropractive Profile best describes you? 
 
Acupuncture
 
Chiropractic Sports Medicine
 
Clinical Neurology
 
Clinical Nutrition
 
Diagnosis and Management of Internal Disorders
 
Diagnostic Imaging
 
Forensic Sciences
 
General Practice
 
Orthopedics
 
Pediatrics
 
Rehabilitation
 
 
 
* Which Dental Profile best describes you?  
 
Dental Assistant
 
Dental Hygienist
 
Dental Lab Tech
 
Dentist (DDS or DMD)
 
Other
 
 
 
 
* What is your primary Dental Speciality? 
 
Dental Public Health
 
Endodontics
 
General Dentistry
 
Oral and Maxillofacial Pathology
 
Oral and Maxillofacial Radiology
 
Oral and Maxillofacial Surgery
 
Orthodontics and Dentofacial Orthopedics
 
Pediatric Dentistry
 
Periodontics
 
Prosthodontics
 
Other
 
 
 
 
* Does your Dental Practice specialize in any of these areas?
 
Sleep sedation or sedation therapy
 
Treating patients with special needs
 
Housecall visits
 
Wisdom teeth removal
 
None of these
 
Other
 
 
 
 
* In what type of Dental Facility do you practice?
 
Private Dental Office
 
Dental Care Chain
 
Other
 
 
 
 
* Which best describes your Eye Care Title? 
 
Dispensing Optician
 
Ophthalmologist
 
Optician
 
Optometrist
 
Optometry Assistant
 
Optometry Technician
 
 
 
* What best describes your Eye Care specialtiy ? 
 
General Optometry
 
Geriatric
 
Laser Vision Correction
 
Low-Vision/Partial Sight
 
Ocular Disease
 
Ophthalmology
 
Pediatrics
 
Sports
 
Vision Therapy
 
Other
 
 
 
 
* Which best describes your Mental Health Professional Job Title? 
 
Addiction Counselor
 
Behavior Analyst
 
Clinical Psychologist
 
Clinical Psychology Associate
 
Clinical Social Worker
 
Counseling Psychologist
 
Marriage and Family Therapist
 
Mental Health Counselor
 
Psychiatric Assistant
 
Psychiatric or Mental Health Nurse
 
Psychiatric Technician
 
Psychiatrist
 
Psychology Intern
 
Psychology Practicum Student
 
Psychotherapist
 
School Psychologist
 
 
 
* Which best describes your primary Mental Health Speciality?
 
Anxiety and Depression
 
Biofeedback
 
Career counseling
 
Child Psychology
 
Cognitive Behavioral Therapy
 
Couples Therapy
 
Family Psychology
 
Geriatric Psychology
 
Industrial-Organizational Psychology
 
Neuropsychology
 
Personality Assessment
 
Psychoanalysis
 
Psychopharmacology
 
PTSD/Trauma
 
Sleep Psychology
 
Sports Psychology
 
Substance Abuse Counseling
 
Treatment of Serious Mental Illness/ Psychosis
 
Other
 
 
 
 
* Which best describes your Primary Nursing Speciality?
 
Advanced Practice
 
Ambulatory Care
 
Burns
 
Cardiac
 
Cardiac Catheter Laboratory
 
Community Health
 
Critical Care
 
Emergency and Trauma
 
Environmental Health
 
Forensic
 
Gastroenterology
 
Genetics
 
Geriatric
 
Holistic
 
Home Health
 
Hospice and Palliative Care
 
Hyperbaric
 
Immunology and Allergy
 
Infection Control
 
Infectious Disease
 
Intravenous Therapy
 
Maternal-Child
 
Medical-surgical
 
Mental Health/Psychiatric
 
Military and Uniformed Services
 
Neonatal
 
Neurosurgical
 
Nurse Midwife
 
Nursing Informatics
 
Nursing Management
 
Nursing Research
 
Obstetrics
 
Occupational Health
 
Oncology
 
Orthopaedics
 
Ostomy
 
Pediatric Oncology
 
Pediatrics
 
Perianesthesia
 
Perioperative
 
Plumonary
 
Private Duty
 
Public Health
 
Radiology
 
Rehabilitation
 
Renal
 
School Nursing
 
Substance Abuse
 
Surgical
 
Telenursing
 
Telephone Triage
 
Transplantation
 
Urology
 
Wound Care
 
Other
 
 
 
 
* Which best describes your NP Speciliaty? 
 
Adult Medicine/Gerontology
 
Family Practice
 
Neonatal
 
Pediatrics
 
Psychiatric-Mental Health
 
Women's Health
 
Other
 
 
 
 
* Which type of Physician are you by speciality?
 
Addiction Medicine
 
Allergy/Immunology
 
Aerospace Medicine
 
Anesthesiology
 
Cardiology
 
Clinical Biochem Genetics
 
Clinical Cytogenetics
 
Clinical Pharmacology
 
Dermatology
 
Diagnostic Radiology
 
Emergency Medicine
 
Endocrinology/Diabetes/Metabolism
 
Epidemiology
 
Family Practice
 
Geriatrics
 
Hospitalist
 
Internal Medicine
 
Legal Medicine
 
Medical Genetics
 
Nuclear Medicine
 
Neurological Surgery
 
Neurology
 
Neurology with Special Qualification
 
Obstetrics & Gynecology
 
Occupational Medicine
 
Oncology
 
Ophthalmology
 
Orthopedics
 
Otolaryngology
 
Osteopath
 
Osteopathic Physician
 
Osteopathic Manipulative Medicine
 
Pain Medicine
 
Palliative
 
Pathology
 
Pharmaceutical Medicine
 
Pediatrics
 
Physical Med and Rehab
 
Plastic Surgery - Specialty
 
Preventive Medicine
 
Psychiatry
 
Public Health and Gen Prevent Med
 
Radiation Oncology
 
Radiology
 
Sleep Medicine
 
Surgeon - General Surgery
 
Surgeon- Abdominal Surgery
 
Surgeon- Colon and Rectal Surgery
 
Surgeon- Complex General Surgical Oncology
 
Surgeon- Cosmetic Surgery
 
Surgeon - Dermatologic Surgery
 
Surgeon - Gastrointestinal surgery
 
Surgeon - Hand Surgery
 
Surgeon - Head & Neck Surgery
 
Surgeon - Oral & Maxillofacial Surgery
 
Surgeon - Pediatric Cardiothoracic Surgery
 
Surgeon- Pediatric Surgery
 
Surgeon- Proctology
 
Surgeon - Surgical Critical Care
 
Surgeon- Thoracic Surgery
 
Surgeon - Transplant Surgery
 
Surgeon - Trauma surgery
 
Surgeon - Vascular Surgery
 
Undersea & Hyperbaric Medicine
 
Other Speciality
 
 
 
 
* What is your Primary Speciality as a Physician Assistant?
 
Addiction Medicine
 
Anesthesia
 
Bariatric Surgery
 
Burn Surgery
 
Cardiology
 
Cardiothoracic Surgery
 
Colorectal surgery
 
Critical Care
 
Dermatology
 
Emergency Medicine
 
Epidemiology
 
Gastroenterology
 
General Surgery
 
Hospitalist
 
Immunology
 
Infectious Disease
 
Internal Medicine
 
Neurology
 
Neurosurgery
 
OB/Gyn
 
Occupational Medicine
 
Oncology
 
Orthopaedic Surgery
 
Pediatrics
 
Pediatric Surgery
 
Plastic & Reconstructive Surgery
 
Psychiatry
 
Radiology
 
Surgical Oncology
 
Transplant surgery
 
Trauma surgery
 
Urgent Care
 
Urology
 
Vascular Surgery
 
Other
 
 
 
 
* Which best describes your other Medical Professional Title?
 
Administrative Assistant
 
Athletic Trainer
 
Audiologist
 
Biomedical Engineer
 
Biomedical Equipment Tech
 
Chief Nursing Officer
 
Clinical Executive
 
Clinical Lab Tech
 
Clinical Nurse Specialist
 
Clinical Technologist
 
Cytotechnologist
 
Dialysis Tech
 
Dietetic Technician
 
Dietician
 
ECG Tech
 
Electroneurodiagnostic Technician
 
Emergency Medical Technician
 
Genetic Counselor
 
Health Educator
 
Health Information Specialist
 
Healthcare Manager
 
Hospital Administrator
 
Hospital Executive
 
Hospital Risk Management
 
Lactation Consultant
 
Materials Manager
 
Medial Library Tech
 
Medical Assistant
 
Medical Coding Specialist
 
Medical Equipment Engineer
 
Medical Lab Technician
 
Medical Librarian
 
Medical Transcriptionist
 
Nutritionist
 
Occupational Therapist
 
Occupational Therapy Assistant
 
Office Manager
 
Payor
 
Pharmacist
 
Pharmacology Research
 
Pharmacy Sales Representative
 
Phlebotomist
 
Physical therapist
 
Physical Therapy Assistant
 
Podiatrist
 
Practice Manager
 
Prosthetist
 
Psychiatric Technician
 
Radiation Therapist
 
Radiation Therapy Tech
 
Radiology Tech
 
Receptionist
 
Respiratory Therapist
 
Respiratory Therapy Assistant
 
Speech Pathologist
 
Supply Chain Manager
 
Surgical Tech
 
Ultrasound Tech
 
 
 
* Which type of Veterinarian are you?
 
Large - Equine
 
Large - Livestock/farming
 
Large - Zoo
 
Small animal
 
Other position in vet industry
 
 
 
* What is your intended Speciality? 
 
Addiction Medicine
 
Adolescent Medicine
 
Allergy
 
Alternative Medicine
 
Anesthesiology
 
Blood Bank/Transfusion Medicine
 
Cardiology
 
Chiropractic
 
Colorectal surgery
 
Critical Care
 
Dentistry
 
Dermatology
 
Ear, Nose and Throat
 
Emergency Medicine
 
Endocrinology
 
Epidemiology/Infectious Disease
 
Forensic Medicine
 
Gastroenterology
 
General Surgery
 
General/Family Practice
 
Genetics
 
Geriatric Medicine
 
Gynecology
 
Hand Surgery
 
Head and Neck Surgery
 
Hematology
 
Hospice/Palliative Care
 
Hospitalist
 
Immunology
 
Internal Medicine
 
Legal Medicine
 
Medical Management
 
Microbiology
 
Nephrology
 
Neurology
 
Neurosurgery
 
Nuclear Medicine
 
Nutrition
 
Obstetrics
 
Occupational Medicine
 
Oncology
 
Ophthalmology
 
Optometry/Opticianry
 
Oral and Maxillofacial Surgery
 
Orthopedic Surgery
 
Orthopedics
 
Pain Management
 
Pathology
 
Pediatrics
 
Pharmaceutical Medicine
 
Plastic Surgery
 
Proctology
 
Psychiatry/Mental Health
 
Public Health
 
Pulmonology
 
Radiology
 
Rehabilitative Medicine
 
Rheumatology
 
Sleep Medicine
 
Sports Medicine
 
Toxicology
 
Transplant surgery
 
Urology
 
Vascular Medicine
 
Other
 
 
 
 
* Please select the profile that best describes your level of experience:
 
Student or Intern
 
One year or less
 
2 - 5 years
 
6-10 years
 
11-20 years
 
More than 20 years