Survey
RequiredRequired Question(s)

By completing our survey you will be entered into our monthly drawing for a $100 Amazon gift card. 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
WHNP
PNP
ARNP
PA
PA-C
MSN
MS
BSN
RN
RNC
MBBS
PhD
Other  
Required 3.

E-mail Address:

 

50 characters left.
Required 4.
What is your gender?
 

50 characters left.

 About Your Practice

 
Required 5.

Practice/Specialty:

Obstetrics
Gynecology
Emergency Medicine
Pediatrics
Neonatology
Family Practice
General Practice
Urgent Care
Other  
Required 6.

Practice Setting:

HMO
Private Practice
Single Specialty Group Practice
Multi-Specialty Group Practice
Community Health Center
Hospital
Academic
Research
Industry (Pharm, etc)
Other  
7.

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

Educational Needs

 
Required 8.

In which of the areas stated below, could your clinical practice be improved if you had additional knowledge and/or skills?  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 9.

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

 

350 characters left.
10.

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

 

350 characters left.
11.

What else could we do to meet your CE needs?

 

350 characters left.

Where You Want To Go

 
12.

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   
Tucson, Arizona   
Houston, Texas   
San Francisco, California   
St. Louis, Missouri   
Seattle, Washington   
Kauai, Hawaii   
Aspen, Colorado (Winter)   
Big Sky, Montana (Yellowstone Nat'l Park - Summer)   
Whitefish, Montana (Glacier Nat'l Park - Summer)   
Chicago, Illinois   
  • Comment:

  • 500 characters left.
13.

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   
Victoria, BC, Canada   
Sydney, Australia   
Trinidad & Tobago   
St. Thomas, USVI   
St. Maarten, Dutch Caribbean   
Atlantis, Nassau, The Bahamas   
Cancun, Mexico   
Jasper, Alberta, Canada (Summer)   
Paris, France   
Buenos Aires, Argentina   
  • Comment:

  • 500 characters left.
14.

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   
Rhône River Cruise (Lyon-Arles - Provence. France)   
Seine River Cruise (Paris - La Havre - Paris)   
Danube River Cruise (Vilshoffen-Budapest)   
Norway Coast River Cruise   
Mediterranean Cruise   
  • Comment:

  • 500 characters left.
15.

List other conference destinations where you would go.

 

350 characters left.

Other Things We Would Like To Know

 
16.
How do you prefer earning your CE credits?
In-person lectures or discussions
Online webinars or videos
Audio recordings
Hands-on workshops, labs, and simulations
Abstract submission
Other  
17.
What social media platforms are you active on?  Check all that apply.
Facebook
LinkedIn
Twitter
Instagram
I am not active on social media
Other  
Required 18.

If you could not attend one of our live conferences, would you be willing to attend the conference virtually?

(Live Stream for less tuition)

Yes
No
  • Comment:

  • 500 characters left.
19.

When you are browsing social media pages, what device do you mostly use? 

Desktop/laptop
Smartphone (iPhone, Android, etc.)
Tablet (iPad, Kindle Fire, etc.)
I am not active on social media
20.

How many Symposia Medicus conferences have you attended?

0
1-2
3-4
5-6
7-9
10+
21.

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

 

350 characters left.