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* 1. FIRST AND LAST NAME

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* 2. EMAIL ADDRESS

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* 3. PLEASE SELECT CREDENTIALS FOR YOUR CERTIFICATE:

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* 4. DID YOU PERCEIVE ANY COMMERCIAL BIAS ASSOCIATED WITH THIS EVENT?

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* 5. IF YOU ANSWERED YES, PLEASE DESCRIBE PERCEIVED BIAS:

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* 6. HAVE YOU IMPLEMENTED THE USE OF TELEMEDICINE IN YOUR PRACTICE IN THE LAST TWO YEARS?

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* 7. PLEASE SELECT YOUR CURRENT STATUS:

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* 8. IF YOU HAVE IMPLEMENTED THE USE OF TELEMEDICINE, PLEASE RANK YOUR EXPERIENCE.  IF YOU DO NOT USE TELEMEDICINE, PLEASE SKIP THIS QUESTION.

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* 9. WHAT NEW STRATEGIES WILL YOU IMPLEMENT BASED ON YOUR PARTICIPATION IN THIS ACTIVITY?

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* 10. PLEASE LIST ANY EDUCATIONAL NEEDS YOU HAVE THAT MAY BE ADDRESSED THROUGH THE KMA CME GUARANTEE ONLINE OFFERINGS:

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