This survey can be used to gather information from practicing physicians. You may print blank copies of this form, have them filled in and scan with an image scanner, or upload the provided image files of pre-filled out forms if you do not have a scanner available. The Word document has been provided so that you may modify this form to meet your needs. Please note that once this form has been modified, the template must be modified as well. Download a free demo of Remark Office OMR to try it out for yourself.