Connectors Project - Clinician Survey

Welcome!

Thank you for taking a few moments to complete this survey! We are interested in how you learn and how you work with your patients. Please complete the following questions so that we can make sure you are getting the information you need to help your patients best manage their epilepsy.

If you have any questions about this program or survey, please contact your local affiliate staff member.

Question Title

* 1. Please tell us the date of the event for which you are registered (ex. if you are registered to attend an Epilepsy Foundation Professional Conference taking place on December 3, 2016, you would include 12/03/2016 here)

Date / Time

Date

Location

Date

Question Title

* 2. We would also like to conduct a follow-up survey in 3 months and 6 months-please indicate how we can contact you:

Phone

Mail

I would prefer not to be contacted (please place an X in the text box to the right to select this option)

20% of survey complete.