Survey for Mentoring Program Development 

Thank you for your interest in small group mentoring! This has been an idea in the works for the past few years, and I am thrilled that it is almost ready to roll out! As a faculty member with Herman & Wallace, I have worked with so many clinicians who are passionate about treating men and women with pelvic floor disorders, but are practicing in situations where they may be the only person within a 100+ mi radius working in this specialty. My goal in creating this program is to not only support clinicians in their growth, clinical reasoning, and knowledge, but also to help them build a community to partner with in the future. 

Your help in this survey is crucial! Please let me know what your preferences are, your level of interest, and any other information to help this be a quality program! 

What is your preference for mentoring? 

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* 1. What is your preference for mentoring? 

How often would you prefer to meet? 

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* 2. How often would you prefer to meet? 

How would you prefer to meet?

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* 3. How would you prefer to meet?

What type of organization would you prefer? 

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* 4. What type of organization would you prefer? 

What is your current practice setting?

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* 5. What is your current practice setting?

What is your experience in pelvic health? 

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* 6. What is your experience in pelvic health? 

What topics/diagnoses are you most interested in?

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* 7. What topics/diagnoses are you most interested in?

  Very Interested  Somewhat Interested Not Interested
Pregnancy-related topics
Post-partum-related topics 
Urinary Dysfunction
Bowel Dysfunction
Sexual Dysfunction
Pelvic Pain 
Coccyx Pain 
Therapeutic Exercise for Pelvic Floor Dysfunction
Manual Therapy Techniques 
Behavioral Interventions in Pelvic Health 
Differential Diagnosis 
Managing Complex Cases 
Return to Sport/Working with Athletes 
Geriatrics 
Pediatric Pelvic Floor Dysfunction 
What is your level of interest in this program? 

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* 8. What is your level of interest in this program? 

Is there anything else you would like me to know? If you are strongly interested in small group mentoring, please include your e-mail address in the space below, and I will contact you with details when they are ready!

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* 9. Is there anything else you would like me to know? If you are strongly interested in small group mentoring, please include your e-mail address in the space below, and I will contact you with details when they are ready!

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