1. Site Information

These questions are an opportunity to learn more about the experiences and capabilities of your medical facility, network, health or advocacy center with regard to the care of adult and adolescent sexual assault (SA) patients/survivors. The information you provide will help us further refine our ideas for the development of a National Sexual Assault TeleNursing Center.

The survey will take approximately 20 minutes.Please respond to the questions as accurately and completely as you can. If you cannot respond to a specific question, feel free to skip over it and leave it blank. Your non response(s) will not in any way disadvantage your facility, nor have a negative influence on your potential participation in a National Sexual Assault TeleNursing Center.

* 1. Site Information

* 2. What type of population is served by your Medical Center/Facility, Network or Advocacy Center?