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| 2. What has caused this? |
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3. Please fill out your name and practice name, for our records, so we don't mistakenly count your survey feedback twice. |
Practice Name: |
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Your Name: |
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| 4. What do you feel you need the most help with in your practice? |
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5. What particular quality is it about your colleagues that you most respect? These are colleagues that you would turn to for advice. Is it: |
| Credentials? Which ones: |
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Practice management related articles in publications? Which topics/author/publication: |
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| Years as private practice PT owner? How many years: |
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| APTA status? Give specifics: |
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| Number of clinics? How many: |
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| Status in community? What particularly: |
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| Other awards/recognition or any other quality you can think of? |
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| How did you hear about us? |
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