The following series of questions help inform our understanding of your continuing medical education interests. We appreciate your participation.

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1. Check the CME categories below that would be of interest to you:

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2. For the topics you indicated above, please tell us any specific topics or speakers that would be of interest to you:

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3. Indicate any OTHER topics/speakers that would be of interest to you:

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4. Indicate specific topics/speakers that you think would be appropriate for our SPRING and FALL CLINICS:

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5. Indicate specific topics that YOU would be interested in presenting at Medical Grand Rounds:

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6. Presuming we can provide relevant, high quality CME, would you consider attending Medical Grand Rounds on a regular basis?

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7. Select your day, time, and method of delivery preferences below

  Day of the Week Time of the Day Delivery Method
Preferences:

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8. Please enter your specialty in the space provided.

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9. Name (Only needed if you are interested in giving a presentation)

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10. Additional comments: 

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