National Wellness Institute - PulseConnect Opt-In Survey Question Title * 1. What is your contact information? Name * Company * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Email Address * Phone Number * Question Title * 2. What is your professional designation? (select all that apply) M.D. (Medical Doctor) D.O. (Doctor of Osteopathic Medicine) N.P. (Nurse Practitioner) P.A. (Physician Assistant) R.D. (Registered Dietitian) L.D.N. (Licensed Dietitian Nutritionist) C.D.N. (Certified Dietitian Nutritionist) R.N. (Registered Nurse) Ph.D. (Doctorate) M.P.H. (Master of Public Health) L.P.N. (Licensed Practical Nurse) C.W.P. (Certified Wellness Practitioner) Wellness Coach Other (please specify) Question Title * 3. What is your practice setting? Outpatient Hospital or Institution Private Practice, Group Private Practice, Solo Inpatient Hospital or Institution University or College Government Agency Public Health Community Health Center or Clinic Other (please specify) Question Title * 4. What topics do you frequently counsel patients and clients on? (select all that apply) Weight Management Diabetes Heart Health Fitness and Exercise Sleep General Nutrition Stress Reduction Digestive/Gut Health Women's Health Children's Health & Nutrition Senior Health Allergies Other (please specify) Done