Partner Survey

Thank you for taking the time to complete this survey. Your feedback is invaluable in helping us tailor our resources to better support you, your patients, and your community. Please share your insights below.

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* 1. Organization/Clinic:

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* 2. Name:

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* 3. Job Title:

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* 4. Email Address:

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* 5. Phone:

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* 6. Business Address

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* 7. What is the size of your practice?

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* 8. What patient population do you primarily serve? (Select all that apply)

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* 9. Please share your current efforts in chronic disease prevention: (Select all that apply)

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* 10. Which areas do you believe your patients need the most support? (Select all that apply)

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* 11. How can we best support your current chronic disease prevention efforts? (Select all that apply)

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* 12. Are you interested in collaborating with us on any of the following? (Select all that apply)

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* 13. What challenges do you face when implementing chronic disease prevention strategies in your practice?

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* 14. Would you like to be contacted to discuss potential collaboration opportunities?

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* 15. Any additional comments or suggestions on how we can better serve you and your community?

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* 16. Would you like to receive updates about our programs and resources?

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