Breast Imaging Forum with Dr. Raman Verma

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* 1. Please enter your first name.

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* 2. Please enter your last name.

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* 3. Please enter your email address.

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* 4. What is your profession?

Radiologist

Technologist

Other (please specify)

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* 5. Please indicate your practice environment.

Community-based hospital

Tertiary-care hospital

Academic centre

Community clinic

Private clinic

Other (please specify)

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* 6. Please indicate your place of work.

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* 7. Please indicate your number of years of practice.

1 year or less

2-5 years

6-10 years

11-15 years

15-20 years

20 years or more

Retired

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* 8. Please choose your meal choice from the selection below.

Pork

Fish

Vegetarian

Vegan

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* 1. Please enter your first name.

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* 2. Please enter your last name.

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* 3. Please enter your email address.

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* 4. What is your profession?

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* 5. Please indicate your practice environment.

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* 6. Please indicate your place of work.

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* 7. Please indicate your number of years of practice.

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* 8. Please choose your meal choice from the selection below.

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* 9. Do you have any dietary restrictions?