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Concussion Pediatric Session Registration
Note: An e-agenda with the link to connect to the session and resources will be sent the workday prior to the session.
*
1.
First Name
(Required.)
*
2.
Last Name
(Required.)
*
3.
Work Organization
(Required.)
*
4.
Profession
(Required.)
*
5.
Postal Code
(Required.)
*
6.
Town/City that you work in
(Required.)
*
7.
Email Address (We will send the e-agenda to this address)
(Required.)
*
8.
Which session(s) would you like to attend?
(Required.)
Management of Pediatric Concussion Symptoms
Diagnosis and Assessment of Pediatric Concussions
Both
9.
We're looking for de-identified patient cases to discuss. Do you have a Pediatric case to present?
Yes
No
10.
Where did you hear about us?
Professional Associates
Colleague
Email
Clinic
Attended other ECHO(s)
Please provide details
