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Please answer the following questions to complete your application:

1. Which best describes the practice for which you work? Check only one.
111 Orthopaedic Surgery
112 Podiatry
113 Physical Therapy
114 Clinical Athletic Training
115 Orthotic/Prosthetic
116 Pedorthic
117 Chiropractic
118 Physiatry
119 Osteopathy
121 Sports Medicine
120 Other:

2. Your Title: Check all that apply.
211 ATC
212 CPO
213 CO
214 CP
215 C. Ped
216 DC
217 DO
218 DPM
219 MD
220 OTR
221 PT
222 PhD
226 PTA
227 BOCO
228 BOCP
224 Student
225 Other:

3. Please describe your involvement in the decision to purchase medical equipment/products for your department: Check all that apply.
511 Approve purchase of product
512 Recommend purchase of product
513 Specify type of product to purchase
514 None of the above.

4. When do you plan to purchase your products?
611 Immediately
612 1 to 3 months
613 4 to 6 months
614 7 months or more

5. What do you purchase and /or recommend? Check all that apply.
520 Ankle braces
521 Hip braces
522 Knee braces

523 Spinal braces
524 Upper extremity braces
525 Footwear/Socks

526 Foot orthoses
527 Prosthetics
528 Rehab/Therapy products and equipment

529 Imaging

6. For what indications do you prescribe pharmaceuticals? Check all that apply.
711 Osteoarthritis
712 Osteoporosis
713 Other joint/muscle pain
715 DVT
716 Nail/Fungal infections
717 Other

7. What role does the Internet play in our practice? Check all that apply.
820 I use the web to learn more about new products
821 I have a website for my practice/organization
822 I order devices and/or materials via the web

823 I purchase devices and/or material via the web
824 I read journals/abstracts online
825 I do not use the web in my practice



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