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Tell us more about you and your practice.

Physician Type *

Practice Information

Are you currently doing research? *
Do you have any dedicated research space? *

Insurance and Practice Demographics (estimates):

Are you enrolled in a Medicate/Medicaid Advantage Program? *

Demographic Breakdown of Practice (%)

Do you employ any of these professionals and do they have clinical research experience?

A) You

C/R

B) MDs/DOs

C/R

C) Physician Assistants?

C/R

D) Nurse Practitioner

C/R

E) Medical Assistants?

C/R

Has anyone on your staff held the following positions in research?

A) Principal Investigator

B) Sub-Investigator

C) Coordinator

D) Assistant Coordinator

Please check which specialties apply to your practice:

A) Internal Medicine/Family

B) Pulmonology

C) Dermatology

D) Neurology

E) Urology

F) Nephrology

G) Cardiology

H) Psychiatry

I) Endocrinology

J) Rheumatology

K) Pain Management

L) Oncology

M) Podiatry

N) Other

Please indicate other ancillary services you provide in your practice:

A) Aesthetics

B) Diagnostic Imaging/Neuro/other

C) Womens' Health

D) Physical Therapy

E) DME

F) Pharmaceutical Dispensing

G) Medical Marijuana

H) Other