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First Name

Last Name

Company

Job Title

Email

Phone

What is your EHR or Practice Management System?

How many providers practice at your organization? 1 to 3 4 to 15 16 to 99 100+ I don't know Does not apply

What is the main specialty of your practice? Allergy/Immunology Anesthesiology Audiologist Cardiology Chiropractic Critical Care (Intensivists) Dentistry Dermatology Emergency Medicine Endocrinology Family Practice Gastroenterology General Practice Geriatric Medicine Hematology Hospice and Palliative Care Hospitalist Infectious Disease Internal Medicine Neonatal Perinatal Medicine Nephrology Neurology Obstetrics/Gynecology Oncology Ophthalmology Optometry Osteopathic Manipulative Medicine Otolaryngology Pain Management Pathology Pediatric Medicine Physical Medicine and Rehabilitation Podiatry Preventative Medicine Psychiatry Psychology Pulmonary Disease Radiology Rheumatology Sleep Medicine Social Work Sports Medicine Surgery Therapy Urology Other

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