Name of Community/Practice

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(Score 5 for yes, 3 for doubtful, and 0 for no)

Rate the Professional Component:

1. Hospital Administration is supportive:
2. The local physicians are supportive:
3. The local lay people communicate a need for my specialty:
4. I am convinced that there exists the need for the skills I offer:
5. I can obtain the hospital privileges I require:
6. The consultation facilities are suitable:
7. The hospital’s support and diagnostic services are adequate:
8. Office space is available that will fit my needs:
9. Skilled office personnel are available at reasonable rates:
10. Cross coverage for time off is available:
11. Post graduate education is accessible:
12. Practice management assistance is available:

Total:

Rate the Economic Component:

1. The area’s population is increasing:
2. The age composition necessary to support my specialty is well represented:
3. The current rates for medical care and services are competitive:
4. Financial assistance is available:
5. The local employment rate is good:
6. The wages are competitive:
7. The industry is stable and diversified:
8. New firms are being attracted to the area:
9. The majority of the population is covered by health insurance:
10. Social services recipients are minimal:

Total:

Rate the Residential Component:

1. My spouse/significant other will be happy here:
2. My spouse/significant other’s career needs will be met here:
3. We are within desired proximity to parents/family:
4. The residential areas are attractive:
5. The price of desired housing is within reach:
6. The zoning ordinances protect property values:
7. Local taxes and assessments appear reasonable:
8. The public services in the area are adequate:
9. The school system is acceptable:
10. The appropriate church is available:
11. Cultural events are readily available:
12. The shopping facilities are satisfactory:
13. The recreation facilities meet our needs:

Total:

Score for Professional Component:

Score for Economic Component:

Score for Residential Component:

Total Score: