AACVPR 2016 Survey for Psychosocial Providers

AACVPR recognizes the increasingly integral role of psychosocial providers in cardiac and pulmonary rehab. The 2016 AACVPR Annual Meeting will offer programming that will be of particular interest for these specialists. In order to notify as many of the appropriate psychosocial specialists as we can, we need your assistance in identifying who they are and whether they may have interest in attending.

If your program has a relationship with a psychosocial specialist please complete this brief survey. Thank you for your participation!

Question Title

* 1. What is the nature of your program's relationship with this psychosocial provider?

Contracted financial relationship

Community provider who accepts your referrals

Employee of your hospital/organization with arrangements to provide services in CR/PR program

Other

Other (please specify)

Question Title

* 2. Would this provider feel comfortable with AACVPR contacting him or her directly? If so, please complete the following contact information:

Name

Phone

Question Title

* 3. Please provide information about yourself:

Name

Title

Hospital/Organization

City & State

Phone

Question Title

* 4. What is your area of specialty?

Cardiac Rehabilitation

Pulmonary Rehabilitation

Both