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* 1. I am currently employed in the United States as a(n):

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* 2. My current employment status is:

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* 3. My work setting at my primary place of employment is:

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* 4. Based on the total number of work hours accumulated at a given geographical location, in the past 6 months, my primary place of employment is in the state of: (select one answer)

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* 5. The patient population(s) served at my primary place of employment, whether by me or other clinical staff, is best described as: (select one answer)

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* 6. The services offered by my primary place of employment, whether by me or other clinical staff, include: (select all that apply; click OK to move to next question)

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* 7. DISPOSABLE supplies refer to clinical items used up quickly (e.g. exam gloves, probe tubes, immittance tips, Earlinks, specula). In the past 6 months, DISPOSABLE supplies were purchased from the following company(ies) for my primary place of employment: (select all that apply; click OK to move to the next question)

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* 8. Based on my answer(s) to the previous question (Q5), in the past 6 months, DISPOSABLE supplies were primarily purchased from: (select one answer)

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* 9. DURABLE supplies refer to clinical items made to withstand continuous use (e.g. otoscopes, ear lights, headlamps, suction pumps).  Excluding diagnostic equipment (e.g. audiometers, tympanometers), in the past 6 months, DURABLE supplies were purchased from the following company(ies) for my primary place of employment: (select all that apply; click OK to move to the next question)

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* 10. Based on my answer(s) to the previous question (Q7), in the past 6 months, DURABLE supplies were primarily purchased from: (select one answer)

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* 11. Excluding price, the most important thing(s) a supply company must offer to keep/gain my business include(s): (select all that are considered critical; click OK to move to the next question)

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* 12. Based on my answer(s) to the previous question (Q9), the single most important thing a supply company must offer to keep/gain my business is: (select one answer)

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* 13. Taking into account my current and past work experience, the total number of years I have been working as an audiologist, audiology assistant and/or hearing instrument specialist is:

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* 14. The main reason(s) I and/or my current primary place of employment buy clinical supplies from a particular company is: 

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* 15. In the past 6 months, my current primary place of employment has participated in the following buying groups, co-ops and/or negotiating networks: (select all that apply; click OK to move to the next question)

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* 16. Provide any additional comments/feedback about this survey topic below: (optional)

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