1. Needs Assessment

Please fill out this survey to aid tailored education planning.

Name

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* 1. Name

Your Practice

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* 2. Your Practice

Email

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* 3. Email

I am a

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* 4. I am a

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Please indicate which speciallties you would be interested in HPMI covering in 2015

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* 5. Please indicate which speciallties you would be interested in HPMI covering in 2015

  Interested
Addiction Medicine
Cardiology
Dermatology
Endocrinology
Emergency Medicine
Evidence Based Medicine
Gastroenterology
Genetics
Geriatrics
Haematology
Infectious Disease
Intensive Care Medicine
Immunology & Allergy
Men's Health
Mental Health
Muscles and Joints
Nephrology
Neurology
Obstetrics and Gynaecology
Occupational Medicine
Oncology
Ophthalmology
Oral Maxillofacial Surgery
Orthopaedics
Paediatrics
Pain Medicine
Palliative Medicine
Pathology
Pharmacology
Public Health
Radiology
Respiratory
Rehabilitation Medicine
Rheumatology
Technology
Please turn to next page for more Specialties
Please indicate which speciallties you would be interested in HPMI covering in 2015

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* 6. Please indicate which speciallties you would be interested in HPMI covering in 2015

  Interested
Men's Health
Sexual Health
Sleep Medicine
Sports Medicine
Surgery
Urology
Vascular
Women's Health
Wound Care
Please provide specific topics for specialties you are interested in

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* 7. Please provide specific topics for specialties you are interested in

List any other specialties or topics

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* 8. List any other specialties or topics

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