We are conducting this survey to help identify your learning needs in thrombosis. Your answers will help us to design new educational programs and materials – thank you!

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* 1. Please indicate your area of healthcare practice:

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* 2. Please indicate your medical specialty, if applicable:

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* 3. Which of the following best describes your clinical practice setting? Choose all that apply.

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* 4. A “practice gap” occurs when there is a difference between actual and ideal performance.

Which of the following subject areas in thrombosis do you believe is most affected by a practice gap? Please select the option that you believe is of HIGHEST priority.

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* 5. For your priority from the previous question, why do you believe there is a practice gap?

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* 6. A “practice gap” occurs when there is a difference between actual and ideal performance.

Which of the following subject areas in thrombosis do you believe is the second-most affected by a practice gap? Please select the option that you believe is of SECOND-HIGHEST priority.

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* 7. For your second choice, why do you believe there is a practice gap?

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* 8. List up to 3 topics in thrombosis that you would most like to see covered in future Thrombosis Canada CME activities?

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* 9. Which of the following skills or procedures related to thrombosis would you like to see addressed in Thrombosis Canada CME educational activities? Please check all that apply.

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* 10. How frequently do you visit the Thrombosis Canada Website (thrombosiscsanada.ca)?

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* 11. Please complete the following if you wish to receive a discount on our annual conference registration:

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