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First Name
Last Name
Company Email
Phone Number
Company Name
How Many Providers Do You Have in Your Organization?
What is Your Role?
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Administrative
C-Level Executive
Director // Manager
Other Clinician
Physician (Non-Owner)
Physician (Owner)
Not Listed
What is Your Medical Specialty?
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Acupuncture
Adult Medicine
Allergy and Immunology
Cardiology
Chiropractics
Dental/Oral Surgery
Dermatology
Emergency Medicine
Endocrinology
ENT
Family Medicine
Gastroenterology
General Surgery
Geriatric Medicine
Gynecology
Hematology
Home Care
Infectious Disease
Internal Medicine
Multi-specialty Clinic
Nephrology
Neurology
Obstetrics
Oncology
Ophthalmology
Optometry
Orthopedics
Pain Management
Pediatric Medicine
Physical Medicine
Podiatry
Preventative Care
Primary Care
Psychiatry - Behavioral Health
Psychiatry - Medication Management
Psychiatry - Talk Therapy
Pulmonology
Rehabilitation
Rheumatology
Skilled Nursing
Sports Medicine
Urgent Care
Urology
Vascular Surgery
Wound Care
Not Listed
Which EHR Vendor Do You Use?
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AdvancedMD
athenahealth
Cerner
Charm
ClaimPower
DrChrono
eClinicalWorks (Cloud-Based)
eClinicalWorks (On-Premise)
Elation Health
Epic
Greenway - PrimeSuite
Kareo
Meditech
NextGen Enterprise
NextGen Office (Meditouch)
Office Ally
Practice Fusion
Veradigm
EHR Not Listed
What State Are You Located In?
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AK
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DE
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MD
ME
MI
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VT
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Non-US
How Did You Hear About Us?
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Someone Told Me About You
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Stumbled Across It on an Internet Search
At a Conference and/or Event
Read About You in an Article
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