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First Name

Last Name

Nickname

Are You a Clinical Specialist?

No, Not a Clinical Specialist

Orthopaedics

Sports

Oncology

Pediatrics

Women's Health

Neurology

Cardiovascular and Pulmonary

EMG

Wound Management

CSCS

None of the above

Other

Area of Specialty

Orthopaedics

Neurology

Sports

Vestibular

Post Surgical

Geriatrics

Strength and Conditioning

Cardiac

Pediatrics

Other

School Where You Received Your DPT?

Undergraduate School

Did You Do a Residency?

Did You Do a Fellowship?

Other Degrees

What is Your Favorite Joint?

Neck

Thoracic Spine

Low Back

SI Joint

Shoulder

Elbow

Forearm, Wrist, and Hand

Hip

Knee

Lower Leg Foot and Ankle

None - I do other things

What Are You Good With?

Ortho injuries and surgeries

Strokes

Shoulder Pain

Back Pain

Neck Pain

Hip Pain

Knee Pain

Foot and Ankle Pain

Wrist and Hand Pain

Return to Run / Running Assessment

Basic Bed Mobility / Transfers

Strength and Conditioning

Sport Specific Training

Long Distance Sports

Extreme Sports

Dancing / Gymnastics

Tactical Athlete

Amputations

Vestibular

Water Sports

Swimming

Other

What is Your Optimal Client?

Elite Athlete

Retired Athlete

Weekend Warrior

Older Adult

Young Adult

Teenager / Children

Women's Health

Men's Health

Orthopaedic Injury

Orthopaedic Surgery

Neurological Impairments

Cardiac Impairments

Vestibular Impairments

Dizziness / Vertigo

Chronic Pain

Amputations

Spinal Cord Injury

Brain Injury

Concussion

Stroke

Swimming

Other

In What City Do You Currently Work?

Occupation

Current Work Setting

My Home

Hospital

Outpatient Clinic

Private Clinic

Nursing Facility

Gym

Travel / In Home

Outdoor / Parks

School / University

Other

Do You Own Your Own Business?

What Do You Do For Fun?

What Are You Interested in Learning?

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