Do you practice in the United States? * Yes No What is your highest attained degree? * MD/DO PhD PA NP RN Other, please specify: What is your highest attained degree? Other, please specify: What is your specialty? * Neurology Psychiatry Geriatrics Family Practice Internal Medicine Other, please specify: What is your specialty? Other, please specify: What is your level of awareness regarding the new 2017 Medicare billing code (G0505) that now provides reimbursement for assessment and care plan development for patients with cognitive impairment? * I am unaware of the code I am somewhat aware of the code I am very aware of the code Is this new code applicable and relevant to your practice and patient population? * Yes, it is relevant No, it is not relevant Have you (or a qualified member of your health care provider team) sought reimbursement utilizing the new G0505 code after providing cognitive assessment and care planning services for Medicare beneficiaries? * Yes No If you have taken advantage of this new C0505 code, please check the box that best describes your experience in providing the required services and in gaining reimbursement: * Positive experience Neutral experience Negative experience Not Applicable If you have already used the new C0505 code to seek reimbursement, how do you expect your use of the code will change over the next 12 months? I expect my usage will: * Increase Decrease Remain the same Not Applicable If you have not yet utilized the new G0505 code for reimbursement, do you plan to use it in the future? * Yes No Do you believe the availability of this new code will help improve the earlier diagnosis and care planning for patients with cognitive impairment? * Yes No If your answer was “NO”, why not? Please provide any additional comment regarding your experience with, or opinion about, the clinical value of the new G0505 code. If you are interested in participating in the raffle for a $100/€100 Amazon gift card, please fill out the following: First Name: Last Name: Email: Leave this field blank