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1. Demographic Information

The purpose of this survey is to help us understand and assess various aspects of arrangements involving Advanced Practice Providers (APPs). Where applicable, please answer questions considering the most recent 12-month period for which information is available.

For questions regarding the survey, contact the following individual:

Matt Jensen
Senior Manager
Coker Group
678.783.5627
mjensen@cokergroup.com

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* 1. What is the name of your organization?

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* 2. Where is your organization headquartered? (City, State)

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* 3. How many APP FTEs are in your organization? (round to nearest whole number)

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* 4. How many physician FTEs are in your organization? (round to nearest whole number)

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* 5. Please select if you would like us to contact you for any of the following (select all that apply):

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* 6. If yes to any of the above, please provide your contact information.

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