2016 Joint Statistics Report Order Form

(based on 2015 data)

Select type of report:

Full Report

Member $500Non-Member $800

Specialty Report

Member $100/SpecialtyNon-Member$250/Specialty

If requesting Specialty Report(s) please check any of the boxes below for your Medical, Dental or Other Specialties.

Medical Specialties

Allergy & ImmunologyAnesthesiologyAnesthesiology/CRNACardiology-InvasiveCardiology-Non-InvasiveCardiovascular SurgeryColon-Rectal SurgeryDermatologyEmergency MedicineEndocrinologyFamily Practice – with ObstetricsFamily Practice – w/o ObstetricsGastroenterology – with EndoscopyGastroenterology – w/o EndoscopyGeneral Internal MedicineGeneral SurgeryHematology/OncologyHospitalistInfectious DiseaseNephrologyNeurologyNeurosurgery
Obstetrics & GynecologyObstetrics & Gynecology – Gyn OnlyOphthalmology – DispensingOphthalmology – Non-DispensingOphthalmology – Retina SurgeryOptometryOrthopedic SurgeryOtolaryngologyPathologyPediatricsPhysical Medicine & RehabPlastic SurgeryPsychiatryPsychologyPulmonary DiseaseRadiologyRadiation TherapyRheumatologyUrologyVascular Surgery

Dental Specialties

EndodonticsGeneral Dentistry – with HygieneGeneral Dentistry – without HygieneGeneral Dentistry – Pedodontics
Oral SurgeryOrthodonticsPeriodonticsProsthodontics

Other Specialties

Ambulatory Surgical CenterChiropracticPhysical TherapyPodiatryMulti-Specialty
Veterinary MedicineD.O. (Doctor of Osteopathy)Pain ManagementConcierge Medicine

All of the following fields are required

Note: If ordering Specialty Reports, enter the total number of specialties checked, on the next page