* 1. What is your First and Last name?

* 2. What is your Title?

* 3. Facility/Organization Name

* 4. At what email address would you like to be contacted?

* 5. Please enter the best contact number where you can be reached.

* 6. Please select the Stroke System of Care you represent. (Select all that apply)

* 7. Are you a participating hospital in the Georgia Coverdell Acute Stroke Registry?

* 8. Are you currently participating in the Georgia Coverdell Acute Stroke Registry post-hospital (rehab) pilot?

* 9. Are you currently involved in the Georgia Coverdell Acute Stroke Registry EMS pilot project?

* 10. EMS agencies ONLY. Does your organization have a community paramedicine EMS program?

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