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1. What year were you born? (*This information will be used to examine generational difference in responses)
   
 
 
 
2. Please indicate your gender (This information will be used to examine difference in responses related to gender)
 
Male
 
Female
 
 
 
3. Please indicate your highest academic degree
 
BS
 
MOT
 
MS
 
MHS
 
OTD
 
DHS
 
EdD
 
PhD
 
Other
 
 
 
 
4. How many years have you practiced as an occupational therapist, in total?
   
 
 
 
5. I am currently practicing:

 
Full time
 
Part time
 
PRN
 
 
 
6. What is your practice setting (mark all that apply)?

 
Acute hospital
 
Inpatient rehab
 
Outpatient rehab
 
Early intervention
 
School systems
 
Sub-acute nursing facility (SNF)
 
Nursing home/Long-term care
 
Home health
 
Other
 

 
 
 
7. Please estimate on average how many miles each client travels to receive services at your setting?
 
0-10
 
11-20
 
21-30
 
31-40
 
41-50
 
50+
 
 
 
8. If you provide home-based services, on average how many miles do you travel to see each client (total # of miles per day/total # of clients per day)?
 
0-10
 
11-20
 
21-30
 
31-40
 
41-50
 
50+
 
 
9. On a scale of 1-5, please rate the amount of knowledge you feel you have regarding telerehabilitation.
1- No knowledge 2 3 4 5- Very knowledgeable
 
 
 
10. On a scale of 1-5, to what extent are you familiar with the American Occupational Therapy Association’s position paper on telerehabilitation?
1- Not familiar 2 3 4 5- Very familiar
 
 
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