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First Name
Last Name
Organization
Your Email Address
Choose Password
Your Age
Job Classification
Physician
Nurse Practitioner
Nurse
Social Worker
Physician Assistant
Medical Student
Nursing Student
Other
Highest Degree Attained
M.D.
Ph.D.
M.S.
B.S.
A.A.
High School Diploma
Other
Years in Practice
0
1 to 5
6 to 10
10 to 15
Over 15
Primary Practice Area
Dermatology
Epidemiology
Family/General Practice
Immunology
Infectious Diseases
Internal Medicine
OB/GYN
Pediatrics
Psychiatry
Other
Primary Work Environment
Private Practice
Public Health
Hospital
Clinic
University
Other
What percentage of patients do you encounter on a monthly basis
whose primary concern is related to an STD?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
To what percentage of clients do you ask at least one sexual
health-related question during a visit?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
What percentage of your patients do you perceive as being at risk
for STDs, including HIV?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
What training courses related to STDs and provider-patient
interactions have you completed?
Additional comments
