Test DEI SurveyBlah BlahDiversity, Equity & Inclusion (DEI) Survey 1. Name * 1. Name First First Last Last2. Which of the following do your consider yourself primarily to be? Academic Surgeon Community Practice Surgeon Hybrid Practice Surgeon Retired3. What is your primary practice setting? Private Practice Solo Private Group Practice Private practice/Part Time HMO Full Time HMO or IRA Full Time Academic Full Time Government (VA) Military Retired OtherOther4. Please indicate your career status. Incoming Fellow (Resident) Fellow 5 years or less with an established vascular practice Over 5 years with an established vascular practice Retired5. Do you consider yourself to have a disability? Yes No Prefer Not to Answer6. What is your race/ethnicity? American Indian/Alaska Native Asian. If you are Asian, and wish to further chracterize, please state here: (eg. Chinese, Japanese, Asian-Indian etc.)Asian. If you are Asian, and wish to further chracterize, please state here: (eg. Chinese, Japanese, Asian-Indian etc.) Black or African American, or African-Caribbean Native Hawaiian/Pacific Islander White Other. If Other, are you willing to indicate your race/ethnicity?Other. If Other, are you willing to indicate your race/ethnicity? Prefer Not to AnswerRace Hispanic/Latino(a). If you are Hispanic and wish to further characterize, please state here: (eg. Mexican, Puerto Rican, etc.)Hispanic/Latino(a). If you are Hispanic and wish to further characterize, please state here: (eg. Mexican, Puerto Rican, etc.) Non-Hispanic/Latino(a) Other Prefer Not to AnswerEthnicity7. With which gender identity do you most identify? Female Male Non-binary Other Prefer Not to AnswerIf Other: Do you consider yourself to be trans-gender? Yes No8. What are your preferred pronouns? He, Him, His She, Her, Hers They, Them, Theirs Prefer Not to Answer9. What is your sexual orientation? Bisexual Gay or Lesbian Straight or Heterosexual Something Else: Something Else: Prefer Not to Answer 10. Other Comments If you are human, leave this field blank. Submit
