DEMOGRAPHICS

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* 1. Please indicate the date of survey:

Date / Time

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* 2. Please indicate your age:

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* 3. Please indicate your gender:

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* 4. Please indicate your race:

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* 5. Please indicate your healthcare discipline:

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* 6. Please indicate where you practice (select more than one if applicable):

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* 7. Please describe the majority of your shifts (select more than one if applicable):

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* 8. Please indicate the best description of the area in which you serve:

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* 9. Please indicate your length of time serving as a healthcare professional:

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* 10. Please indicate your zip code of residence:

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