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Thank you for participating in the Doctor’s Survey for our 2007 Healthcare Issue. Your input is valuable and greatly appreciated. Please take a few moments to review our survey rules.

Rules for Participation:

In fairness to your colleagues, please submit only ONE survey per physician. If your practice employs multiple physicians, each physician may submit one survey. Please direct each physician to our online survey and ask them to complete and submit.

All duplicate submissions will be eliminated from the results.

For faxable version of Doctor's Survey, please click here to download.

Please complete and submit by October 31, 2007.

Fields in red are required and cannot be left blank.

Doctor's Name:
Practice Name:
Specialty:
Email Address:
Practice Address:
City:
State, Zip:	,

Who would you send your patients to? (Please use Doctor's First and Last Name if possible)
Allergy/Asthma
Cardiology
Chiropractor
Colorectal Surgery
Cosmetic/Plastic Surgery
Dentist
Dermatology
ENT
Endocrinology
Family/Internal Medicine
Gastroenterology
Gynecology
Infectious Disease
Nephrology
Neurology
Neuro Surgery
Obstetrics
Oncology
Ophthalmology
Optometry
Oral Surgery
Orthopedic
Pediatrician
Physical Therapists
Psychiatrist/Counseling
Podiatrist
Pulmonary
Rheumatology
Surgeons – General
Urology


Practice Manager's Name:
Email Address:

Physician’s / Practice Profile Spaces and General Advertising Spaces are limited. Would you like to be contacted about advertising?
YES NO

Would you like free copies of the 2007 Healthcare Issue delivered to your office,?
YES NO

Would you like a copy of the 2006 Healthcare Issue? (Please note that the quantities are limited)
YES NO

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