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* 1. Please indicate areas of interest for PADONA educational programs.

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* 2. What additional subjects would you like PADONA to offer? (Include possible speakers.)

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* 3. Which do you prefer? (Check as applicable.)

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* 4. What are the most convenient day(s) of the week for you and/or your staff to attend programs? (Starting with 1 being the most convenient and 6 being the most inconvenient.)

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* 5. After attending an educational program, what percentage of the time are you able to recommend changes in the care provided?

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* 6. After attending an educational program, what percentage of the time are you able to share this information with your staff?

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* 7. How many educational programs are you able to attend a year?

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* 8. Please indicate the level of importance of CEUs when attending educational programs:

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* 9. Of the following host locations in Area I (Western PA), please number those you would likely attend for an educational program, with 1 being the most likely.

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* 10. Of the following host locations in Area II (Central PA), please number those you would likely attend for an educational program, with 1 being the most likely.

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* 11. Of the following host locations in Area III (Eastern PA), please number those you would likely attend for an educational program, with 1 being the most likely.

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* 12. What is a convenient location for you to attend programs that is not listed as a host above (include city, state and preferred facility)?

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* 13. If you are willing to host an area meeting, please provide your name and phone number:

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* 14. If you are willing to host an area meeting, please indicate the time(s) you would host.

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