2024 Annual Provider Survey

Demographic Information

Question Title

* 1. Your Name

Question Title

* 2. Email Address

Question Title

* 3. Provider Group/Practice Name

Question Title

* 4. County of Practice/Group

Question Title

* 5. Scope of Practice

Primary Care

Specialty Care

Behavioral Health

Hospital

Ancillary Services (i.e. DME, Lab)

Other (please specify)

Question Title

* 6. How many practitioners are in your practice?

1-5

6-10

11-24

25-99

100+

Question Title

* 7. How many years have you been in practice?

0-2

3-5

6-10

11-19

20+