Pain Assessment Survey

2. Sex

• Male
• Female

3. Race

• Caucasian
• African American
• Asian
• Native American
• Other (Please Specify) Please enter an 'other' value for this selection.

5. Highest Degree

• MD/DO/MBBS
• Nurse Practitioner
• Physician Assistant
• RN
• Bachelors
• PhD (Specify Subject) Please enter an 'other' value for this selection.
• Masters (Specify Subject) Please enter an 'other' value for this selection.
• Other (Please Specify) Please enter an 'other' value for this selection.

7. Role in Practice

• Partner/Owner
• Attending Physician
• Primary Healthcare Staff
• Nursing Staff
• Psychologist
• Pharamacist
• Resident or Fellow

9. Does someone in your practice perform interventional procedures and if so, what methods?

• Medications only
• Medications and Rehabilitation
• Medications and Interventions
• Medications, Rehabilitation, and Interventions
• No, my practice does not perform interventional procedures

11. Specialties represented in the practice at least once a week (select all that are applicable)

• Anesthesia
• Oncology
• Neurology
• Psychiatry
• Physical/ Rehab medicine
• General medicine
• Psychology
• Physical therapy
• Addiction counselors
• Other physician specialities (Specify) Please enter an 'other' value for this selection. * This question is required.
• Other (Specify) Please enter an 'other' value for this selection. * This question is required.

14. Academic affiliation

• Yes
• No