1. What is your professional title?

2. Are you:

3. What is your race/ethnicity?

4. What is your practice/center?

5. What is your specialty?

6. Are you in a management position within your practice/center?

7. Approximately how many patients has your practice/center served in the last 12 months?

8. Of the patients you served within the last 12 months, how many were:

9. Are you a VFC (vaccine for children) provider?

10. In what county(ies) do most of the patients you serve live? (check all that apply)

11. List the zip code(s) of your practice(s)/center(s)?

12. Would you be willing to provide influenza vaccine data (by race, age and gender) to SC DHEC Office of Minority Health at the end of the 2011-2012 and 2012-2013 flu seasons?

9% of survey complete.