Mentor Questionnaire

* 1. Demographic information:

* 2. Specialty:

* 3. Practice setting:

* 4. Percentage of PAG in your practice:

* 5. Surgical volume:

* 6. Interest in research:

* 7. Desire to host international member:

* 8. Number of mentees:

* 9. Please explain what goals you would like to achieve with your mentee:

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