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Surveys
2013
July
P
Practice survey
Practice survey
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Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
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button below.
I Agree
*
Are you a practicing physician?
Yes
No
Retired
*
What is your board certification?
Dermatology
Otolaryngology
General Surgery
Plastic Surgery
Other
Since the end of residency/fellowship, how many years have you been in practice?
0-5
6-10
11-15
16-20
20+
Did you complete fellowship training?
Yes
No
What type(s) of fellowship training did you complete?
No fellowship
Procedural dermatology- ACGME accredited
Mohs surgery- ACMS accredited
Independent dermatologic, cosmetic, or laser
ENT facial plastic surgery
Plastic surgery
Other
What was the total length of your fellowship training?
1 year
2 years
3 years
4 years
5+years
No post-residency fellowship
Other
Do you perform office-based surgical procedures?
Yes
No
On an average week, how much time do you dedicate to office based procedures?
0-1 days
2-2.5 days
3-3.5 days
4-4.5 days
5+ days
What kind of procedures do you perform in the office (under local or tumescent anesthesia)?
Excision
Mohs micrographic surgery
Flaps
Grafts
Botox
Fillers
Dermabrasion
etc
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