MCC Study: Pediatric Recruitment Survey

Question Title

* 1. Your Name (first, last):

Question Title

* 2. Email Address:

Question Title

* 3. What is the name of your site or hospital system?

Question Title

* 4. In what city is your site located?

Question Title

* 5. In what state is your site located?

Question Title

* 6. Is your site interested in participating as pediatric site?

Yes

No

Question Title

* 7. What is the average daily pediatric census at your facility?