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1. Which of the following best describes your practice?
   • solo, single-specialty
   • solo, generalist
   • small group, single-specialty
   • small group, generalist
   • large group, single-specialty
   • large group, multispecialty or multidisciplinary
2. Which of the following best describes your competitive market area?
   • extremely competitive (10 or more practices in my specialty)
   • moderately competitive (4 to 9 practices in my specialty)
   • lightly competitive (1 to 3 practices in my specialty)
   • I have no competition
3. Which of the following best describes the relative size of competitive practices?
   • mostly larger
   • mostly smaller
   • about the same size
   • all different sizes (from solo to large groups)
4. Which of the following best describes public awareness of your competitors?
   • well-known, high awareness
   • somewhat known, moderate awareness
   • unknown, no awareness
5. Which of the following best describes your competitors’ reputations?
   • outstanding
   • good
   • average
   • not so good
   • bad
6. Which of the following best describes your competitors’ marketing?
   • heavy volume, high-quality
   • heavy volume, low-quality
   • moderate volume, high-quality
   • moderate volume, low-quality
   • no visible marketing
7. Where would you rank your practice among your competitors?
   • market leader
   • among the best
   • middle of the pack
   • we can do better

Please provide the following information. Your survey results cannot be calculated without it.

^* Required

• ^*Name
• ^*Are you the practice owner
  • Yes
  • No
• If you're not the owner, what is your role in the practice?
• Practice Owner's Name
• Profession
• Specialty (if any)
• Practice Name
• ^*Address
• ^*City
• ^*State
• ^*Zip
• ^*E-mail
• ^*Phone
• ^*Fax
• Best time to call
• Best number to call
• Home Phone (optional)
• Cell Phone (optional)
• ^*Code

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