Symposia Medicus
RequiredRequired Question(s)

By filling out our survey you will be entered into our monthly drawing for a free tuition for the conference of your choice. By entering your personal information, you consent to receive e-mail communications from Symposia Medicus. Incomplete forms are ineligible for the drawing.
 

                             
                                                About You
 
Required 1.

Please enter the information indicated below.

First Name:
Last Name:
State/Province
(US/Canada):
Country:

Required 2.

Degree:
MD
DO
CNM
FNP
PNP
ARNP
PA
PA-C
MSN
MS
BSN
RN
RNC
MBBS
PhD
Other  
Required 3.

E-mail Address:
 

50 characters left.

                             
                                                About Your Practice
 
Required 4.

Practice/Specialty:
OB/GYN
Obstetrics
Gynecology
Women's Health
Emergency Medicine
Pediatrics
Pediatric Emergency Medicine
Adolescent Medicine
Family Practice
General Practice
Internal Medicine
Hospital Medicine
Other  
Required 5.

Practice Setting:
Private Practice
HMO
Single Specialty Group Practice
Multi-Specialty Group Practice
Community Health Center
Hospital
Academic
Research
Industry (Pharm, etc)
Other  
6.

How long have you been in practice?
Less than five years
Between six and ten years
Between eleven and twenty years
More than twenty years

                                    
                                                Why You Attend
 
7.

What THREE factors are most important to you when
deciding on attending a conference?
                                   (Please check three)
Content
Cost of tuition
Location
Reputation of conference sponsor
Reputation of conference presenters
Need for credit
Other  
8.

Have you ever attended a Symposia Medicus conference?
Yes
No

                                    
                                                Educational Needs
 
Required 9.

In which of the areas stated below, could your clinical practice be improved if you had additional knowledge and/or skills?  Please check all that apply
Communication between care providers and patients
Interdisciplinary team collaboration and cooperation
Quality improvement ideas for health care systems & patient safety
Infomatics - using information technology to support decision making
Required 10.

Please list clinical topics that would assist you in more effectively providing better patient care:
 

350 characters left.
11.

Please list non-clinical topics that would assist you in more effectively providing better patient care:
 

350 characters left.
12.

What else could we do to meet your CE needs?
 

350 characters left.

                                  
                                                            Where You Want To Go
 
13.

Please rate the following destinations in the USA by how likely you would attend a conference there:
(if you select maybe, tell us what would change your answer to a yes)
 No Maybe Yes   
Monterey/Carmel California   
Miami Beach (South Beach)   
Honolulu   
Yosemite   
Orlando   
Grand Canyon (South Rim)   
Whitefish, Montana-Glacier National Park (Summer)   
Sun Valley (Winter)   
Park City (Winter)   
Seattle   
  • Comment:

  • 500 characters left.
14.

Please rate the following destinations outside the USA by how likely you would attend a conference there:
(if you select maybe, tell us what would change your answer to a yes)
 No Maybe Yes   
St. Maarten/St. Martin   
St. Lucia   
Vancouver, Canada   
Jasper National Park, Canada (Summer)   
Ixtapa, Mexico   
Cancun, Mexico   
Cozumel, Mexico   
Whistler, Canada (Winter)   
Niagara Falls, Canada (Summer)   
Dominican Republic   
  • Comment:

  • 500 characters left.
15.

Please rate the following cruise ship destinations  by how likely you would attend a conference there:
(if you select maybe, tell us what would change your answer to a yes)
 No Maybe Yes   
New England/Canada Coast (5 days - mid September)   
Australia-New Zealand (12 days- late January)   
Southern Europe (So. France, Italy, Spain- 7 days-early Oct)   
Northern Europe (England, No. France, Holland- 8 days -early Sept)   
Scandanavia & Russia (12 days-mid- July or early August)   
South East Asia-Hong Kong to Singapore (14 days-mid February)   
Panama Canal (15 days - early Oct)   
Mexico (Pacific Coast- 5 days)   
West Coast Wine Cruise (5 days- mid May)   
Eastern Caribbean (Aruba, Barbados, Cozumel- 7 days)   
  • Comment:

  • 500 characters left.
16.

List any other destinations where you would like us to
hold a conference:
 

350 characters left.


                        Other Things We Would Like To Know
 
17.

Would you prefer your conference syllabus (with reprints of PowerPoint slides, references and abstracts) be ONLYoffered on electronic media (thumb drive or downloaded from our web site in Adobe PDF format) in order to reduce our impact on the environment?
Yes
No
  • Comment:

  • 500 characters left.
18.

If you were unable to attend one of our conferences, would you pay a reduced tuition to watch a video of the conference online, download the syllabus, and take a quiz for CE credit?
Yes
No
  • Comment:

  • 500 characters left.
19.

How can we improve our website to better meet your educational needs?
 

350 characters left.