Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Specialty Services Survey Question Title * 1. Please enter the following information Name Name of Practice Address Address 2 City/Town Zip/Postal Code Email Address Phone Number Staff Size Broadband or T1 Lines? OK Question Title * 2. How many doctors do you have? 1-10 11-20 21-30 31-40 41-50 51-100 OK Question Title * 3. Do you currently have any specialists in your practice setting? Yes No OK Question Title * 4. Is there a need for greater access to specialists in your practice? Yes No OK Question Title * 5. Do you feel that having specialty/collaborative care available to your practice via telehealth would be beneficial? Yes No OK Question Title * 6. Please rate the following telehealth specialty services according to added value for your practice: No Importance Extremely Important Neurology Neurology No Importance Neurology Extremely Important Psychiatry Psychiatry No Importance Psychiatry Extremely Important Cardiology Cardiology No Importance Cardiology Extremely Important Bariatric Treatment and Consultation Bariatric Treatment and Consultation No Importance Bariatric Treatment and Consultation Extremely Important Gastroenterology Gastroenterology No Importance Gastroenterology Extremely Important Sleep Sleep No Importance Sleep Extremely Important Substance Use Disorder Specialist Substance Use Disorder Specialist No Importance Substance Use Disorder Specialist Extremely Important Dermatology Dermatology No Importance Dermatology Extremely Important Plastic Surgery Consultation Plastic Surgery Consultation No Importance Plastic Surgery Consultation Extremely Important OK Question Title * 7. Q6. Please rank the following age group by identifying their level of need for specialty telehealth services within your practice: 0 - 17 years0-Low 1-Below Average 2-Average 3- Above Average 4-High 0 1 2 3 4 0-17 years 0-17 years 0 0-17 years 1 0-17 years 2 0-17 years 3 0-17 years 4 18-25 years 18-25 years 0 18-25 years 1 18-25 years 2 18-25 years 3 18-25 years 4 26-55 years 26-55 years 0 26-55 years 1 26-55 years 2 26-55 years 3 26-55 years 4 56 years and older 56 years and older 0 56 years and older 1 56 years and older 2 56 years and older 3 56 years and older 4 OK Question Title * 8. Do you have an exam room with internet access? Yes No OK Question Title * 9. Please provide any additional comments regarding the benefits or challenges of specialty telehealth services as it relates to yourpractice. OK DONE