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Which best describes your occupation / type of involvement in the Healthcare industry?

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Which of the following best categorizes your current degree attainment status?

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How would you classify your primary practice setting?

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Private Practice
Group Practice
Other
General Hospital
Teaching Hospital
Ambulatory Care Center
Long Term Care/Nursing Home

What is your primary specialty?

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Which of these Allergy & Immunology sub-specialties are you involved with? Please select all that apply.

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Allergy
Allergy & Immunology/Diagnostic Lab
Allergy & Immunology
Immunology
Pediatric Allergy
Pediatric Immunology
None of the above
Other

Which of these Anesthesiology sub-specialties are you involved with? Please select all that apply.

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Critical Care Anesthetics
Pain Management Anesthetics
None of the above
Hospice and Palliative Medicine

Which of these Cardiology sub-specialties are you involved with? Please select all that apply.

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IM - Cardiac Electrophysiology
Interventional Cardiology
Nuclear Cardiology
None of the above

Which of these Dermatology sub-specialties are you involved with? Please select all that apply.

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Dermatopathology
Pediatric Dermatology
None of the above
Cosmetic Dermatology

Which of these Emergency Medicine sub-specialties are you involved with? Please select all that apply.

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Emergency Medical Toxicology
Emergency/Sports Medicine
Hospitalist
Pediatric Emergency Medicine
Undersea and Hyperbaric Medicine
Urgent Care Medicine
None of the above

Which of these Endocrinology, Diabetes & Metabolism sub-specialties are you involved with? Please select all that apply.

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Diabetes
Reproductive Endocrinology
None of the above

Which of these Family Practice / General Practice sub-specialties are you involved with? Please select all that apply.

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Adolescent Medicine (Family Practice)
Geriatrics
Sleep Medicine
None of the above

Which of these Gastroenterology sub-specialties are you involved with? Please select all that apply.

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None of the above
Hepatology

Which of these Genetics sub-specialties are you involved with? Please select all that apply.

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Clinical Biochemical Genetics
Clinical Cytogenetics
Clinical Genetics
Clinical Molecular Genetics
Medical Genetics
Metabolic Genetics
Molecular Genetic Pathology
Pediatric Genetics
None of the above

Which of these Geriatrics sub-specialties are you involved with? Please select all that apply.

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Family Practice-Geriatric Med
Geriatric Psychiatry
Hospitalist
Internal Medicine - Geriatrics
Other
None of the above
Long-term Care Geriatrics

Which of these Hematology sub-specialties are you involved with? Please select all that apply.

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Hematology/Oncology
Pediatric Hematology
None of the above

Which of these Infectious Diseases sub-specialties are you involved with? Please select all that apply.

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HIV/AIDs Specialist
None of the above

Which of these Obstetrics & Gynecology sub-specialties are you involved with? Please select all that apply.

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Gynecology
Maternal & Fetal Medicine
Reproductive Endocrinology
Surgery
Gynecologic Oncology
None of the above

What type of oncology do you specialize in? Please select all that apply.

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Clinical Oncology
Gynecological Oncology
Hematology/Oncology
Medical Oncology
Orthopedic Musculo Oncology
Pediatric Hematology Oncology
Radiation Oncology
Surgical Oncology
None of the above

Which of these Ophthalmology sub-specialties are you involved with? Please select all that apply.

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Pediatric Opthalmology
Retinal Specialists
None of the above
Glaucoma Specialist

What type of orthopedics/Orthopedic Surgery do you specialize in? Please select all that apply.

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Hand Surgery
Orthopedic Surgery of the Spine
Adult Recon Surgery
Orthopedic Pediatric Surgery
Orthopedic Sports Medicine
Orthopedic Surgery - Trauma
Orthopedics (Foot & ankle)
None of the above

Which of these Otolaryngology / ENT sub-specialties are you involved with? Please select all that apply.

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Otology - Neurotology
Pediatric Otolaryngology
Plastic Surgery - Head & Neck
None of the above
Sleep Medicine

Which of these Physical Medicine & Rehabilitation sub-specialties are you involved with? Please select all that apply.

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Pediatric Rehabilitation Medicine
Spinal Cord Injury
Sports Medicine
None of the above

Which of these Plastic / Cosmetic Surgery sub-specialties are you involved with? Please select all that apply.

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Bariatric Surgery
Craniofacial Surgery
Facial Plastic Surgery
Laproscopic Surgery
Reconstructive Surgery
None of the above

Which of these Preventive Medicine sub-specialties are you involved with? Please select all that apply.

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Aerospace Medicine
Occupational Medicine
Preventive Medical Toxicology
Public Health/General Prevent Med
Undersea Medicine
None of the above

Which of these Pulmonology sub-specialties are you involved with? Please select all that apply.

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Hospitalist
Pulmonary Critical Care Med.
None of the above
Pulmonary Critical Care Medicine/Intensivist
Sleep Medicine

Which of these Rheumatology sub-specialties are you involved with? Please select all that apply.

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Pediatric Rheumatology
None of the above

Which of these Urology sub-specialties are you involved with? Please select all that apply.

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Pediatric Urology
Proctology
Urological Surgery
None of the above
Female Pelvic Medicine and Reconstructive Surgery

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