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2024 Annual Provider Survey
Demographic Information
1.
Your Name
2.
Email Address
*
3.
Provider Group/Practice Name
(Required.)
4.
County of Practice/Group
*
5.
Scope of Practice
(Required.)
Primary Care
Specialty Care
Behavioral Health
Hospital
Ancillary Services (i.e. DME, Lab)
Other (please specify)
6.
How many practitioners are in your practice?
1-5
6-10
11-24
25-99
100+
7.
How many years have you been in practice?
0-2
3-5
6-10
11-19
20+
