This survey will take approximately 15 minutes to complete. It is recommended that you print each survey page after entries are made. To return to a prior page select the "Back" button at the bottom of each survey page; do not use your browser's back button. To complete the survey you must select the "Submit" button at the end for your entries to be recorded. If you require assistance with any part of this survey, please email Hannah.Leingang@doh.wa.gov or call (360) 236-2832.For those surveying on behalf of several providers you will need to complete a survey for each individual. For your convenience a Print Survey is available.Information collected via this survey may be subject to release under RCW 42.56 (Public Records Act).Select "Start" to begin the survey.