Advanced A/P Correction Course Survey- Feb 2023

Attending Doctor Name *

First

Last

Doctor Cell Phone Number *

This will only be used for communication about the course.

Doctor NPI Number

We need this to issue CE. You can look it up at https://npiregistry.cms.hhs.gov/search If you don't have one, leave it blank.

Email *

This will be where we will send all updates/communication regarding the course.

Practice Name *

(If you're a resident, let us know what school you're attending)

Practice Location *

What's your Starbucks Order?

Do you have any dietary restrictions?

What topics are you hoping to discuss during the course?

What is the most important thing you are looking to learn from the course?

Other than the planned clinical content, what else are you hoping to learn at the course?

(i.e. Marketing, Lab, TC, Admin, etc.)

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