Fight the Cause of Allergies Survey Thank you for your interest in the Fight the Cause Campaign!  We look forward to partnering with you.  Together we can increase the number of allergic patients who get properly diagnosed and treated by allergy specialists.  Please remember to provide your mailing address so we can send you your free gift.  Your Name   Title   ALK Account Number   Physician/Practice Name   Street Address   City, State, Zip Code   Email Address   Phone #   Practice Specialty     1 What % of your patients are tested for allergies? Less than 35% 35 - 50% 50 - 75% Greater than 75% 2 Why do you think only a small percentage of allergic patients are ever tested by a specialist? (Please choose all that apply) Lack of awareness of Immunotherapy treatment and its benefits Few referrals of allergic patients Fear and skepticism of Immunotherapy by population Lack of support by managed care groups 3 What % of your patients are receiving Immunotherapy? Less than 20% 20 - 35% 35 - 50% 50 - 60% Greater than 60% 4 What is the estimated number of patients on Immunotherapy in your practice? Less than 250 250 - 500 500 - 1,000 1,000 - 2,000 Greater than 2,000 5 What is the most popular reason that IT appropriate patients deny or reject IT?  Inconvenience (time commitment) Co-pays Fear of shots/fear of anaphylaxis Not convinced of efficacy 6 Would you see SLIT as a way to expand your patient base or as a threat to your current practice? Growth opportunity Threat 7 How many allergens are in your testing panel? 16 or less 17 - 24 25 - 48 Greater than 48 8 What skin testing system do you currently use? Multi-Test, Multi-Test II, Duotip Test, or Duotip Test II GreerPick or Skintestor Omni Quintip or Quintest Accuset Intradermal Other 9 How do most new patients find you and your practice? Physician Referrals Patient Referrals Advertising/Marketing Insurance 10 Who do your physician referrals most often come from?  Ex: GPs, Pediatricians, Emergency Rooms, Pulmonologists, etc. 11 Would you be interested in strengthening your overall referrals? Yes No 12 What is the largest challenge you face in growing your practice? Too much competition Limited financial resources Lack of patient base Limited insurance reimbursement Limited marketing capabilities 13 What % of IT patients drop out before reaching maintenance? Less than 20% 20 - 35% 35 - 50% Greater than 50% 14 What is the main reason for dropping out? Inconvenience (time commitment) Co-pays Fear of shots / fear of reactions Not convinced of efficacy 15 What is the largest challenge you face with Managed Care/Insurance companies? Lack of knowledge of IT benefits Lack of confidence in Allergist treatment methods Lowering reimbursements Other 16 What is the primary way you market your practice? Yellow Pages / Phone Book Online Directory or Website Local Magazines, Newspaper, etc. Local Physician Offices Other I do not currently market my practice 17 What is your current growth rate? Less than 5% 5 - 10% 11 - 20% Greater than 20% 18 Use of computer and information technology (Please choose all that apply) Have internet use in office Have immunotherapy mixing and administration software (Rosch, Mountainside, etc) Have EMR System I would like assistance in automating my practice 19 Who is your current Primary Extract Supplier? ALK-Abello Greer Hollister Stier Other 20 How can ALK-Abelló better assist your practice with its growth? (Please choose all that apply) Marketing assistance Referral development Patient Literature on Immunotherapy, etc Direct to consumer advertising Consulting to improve efficiency 21 How did you hear about the “FIGHT THE CAUSE” Partnership Program? Fax Flyer Package Insert Website ALK Abello Allergy Consultant Other 22 Any additional comments? Thank you for your time!

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