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• Full name✱
• Email✱
• Phone ✱
• Current location
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• Current company

US - Lead Specialized Men's Health

• Where did you hear about this job?✱
• Which US state do you live in?✱
• Are you qualified as a Nurse Practitioner or Physician Associate?✱

  • NP
  • PA
• If NP - how many active NP state licences do you have? (please list)
• If PA - how many active state licences do you have?
• How many years of post-qualification experience do you have?✱

  • 0-5
  • 5-7
  • 7+
• Please describe your experience of working within specialized men's health, particularly within testosterone management, sexual dysfunction, and similar areas.✱
• How many years of telehealth experience do you have?

  • 0-1
  • 1-3
  • 3-5
  • 5+
• Please tell us about your experience in clinical leadership?

Demographic Survey for Peppy

We invite you to complete this optional survey to help us evaluate our diversity and inclusion efforts. Submission of the information on this form is strictly voluntary and refusal to provide it will not subject you to any adverse treatment or affect your job application. Information obtained will be kept separate from your name or job application. This information will be kept secure and confidential and will be used solely to evaluate our diversity and inclusion efforts.

• What is your age range?
  • 17 or younger
  • 18-20
  • 21-29
  • 30-39
  • 40-49
  • 50-59
  • 60 or older
• I identify my ethnicity as

  Select all that apply

  • Asian
  • Black
  • Mixed / Multiple-Ethnic Groups
  • Other race, ethnicity, or origin
  • White
  • Prefer not to say
• What gender do you identify as?
  • Female
  • Male
  • Transgender Male
  • Transgender Female
  • Non-binary
  • Prefer not to say
• Do you consider yourself to be disabled ?
  • Yes
  • No
  • Prefer not to say
• Which sexual orientation do you identify with?
  • Bi-Sexual
  • Gay / Lesbian
  • Heterosexual / Straight
  • Other
  • Prefer Not to say