Select... Clinic Consulting Firm Hospital Mental Health Organization Nursing Home Physician Practice Public Health Department Rehabilitation Center Skilled Nursing Facility University and/or Research Institution Other (describe below)

 If "Other" please elaborate:

 Describe briefly the type(s) of patients you see:

 How many patients do you see annually?  

 How many staff are employed at your organization?

*Is your organization... profit  or not-for-profit?  (check one) 

 Describe briefly what your roll is in your organization:

 Describe briefly where you are in the process of implementing an
 Integrative Medicine Program:

 Describe briefly what level of support you have:

*Have you read our Building Bridges online book?  Yes No
 (If you haven't, CLICK HERE to view it!)

 What other issues would you like to discuss when we contact you?

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