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* 1. I am a:

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* 2. Area of Primary Practice:

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* 3. Area of Secondary Practice (if applicable):

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* 4. How many years have you been in the profession?

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* 5. Has COVID-19 impacted the number of hours you work per week?

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* 6. If you answered yes to #5, what percentage of your normal work week hours have you been able to work?

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* 7. If your hours were not impacted by COVID-19, did you: (check all that apply)

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* 8. If you are an employer, how easy has it been to obtain appropriate PPE for your employees?

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* 9. If you are an employee, were you provided PPE by your employer?

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* 10. Are you currently using telemedicine (telehealth) in your practice setting?

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* 11. If you are using telemedicine, what percentage of your normal case load (Pre-COVID-19) is receiving physical therapy via telemedicine?

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* 12. If you are not using telemedicine, what are the barriers that are keeping you from doing so? (check all that apply)

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* 13. Have you personally been diagnosed with COVID-19?

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* 14. What can APTA Indiana do to help you at this time?

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* 15. Optional - Please provide your name and location.

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