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Please type responses here: |
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First name:
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Last name:
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Email Address:
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Retype Email Address:
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Phone number:
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Institution:
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Title:
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Address:
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City:
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State:
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Country:
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Zip/Postal Code:
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At what type of laboratory are you currently employed?
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Hospital
Reference
Academic
Physician Office
Other
I do not work in a laboratory
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If you chose 'Other' above, please describe the type of laboratory at which are you currently employed:
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My credentials (i.e., MD, RN, PHD, etc.): Please fill in the blank:
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I practice/work in: (select all that apply)
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Laboratory
Emergency
Hospital
Urgent Care
Primary Care
Pharmacy
Specialized clinic
Long-term Care/Nursing home
Other clinical setting
Medical Distributor/Manufacturer/Supplier (If selected, please skip to the following question)
Non-clinical setting
Other
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I specialize in: (select all that apply)
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Pediatrics
Family Medicine/Internal Medicine
Emergency Medicine
Urgent Care
Student/Resident
Administration
Pharmacy
Other area of clinical care
Operations/Practice Management
Other
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Have you directly worked on or influenced laboratory stewardship projects within your facility?
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Yes
No
I don’t know
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Does your facility have an active laboratory stewardship committee?
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Yes
No
I don’t know
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By registering for this webinar, Whitehat uses your information to communicate with you regarding this webinar and other educational events.
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Yes, I consent to give my information to receive communication regarding this webinar
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By registering for this webinar, the information you provide will be shared with the webinar’s sponsor to provide you with information on products and services that may be of interest to you:
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Yes, I consent to receiving marketing communication from this webinar’s sponsors following the webinar
No, thank you
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After clicking 'submit', you
will be redirected to the webinar recording.
You will also
receive an email with the link to the evaluation to fill out
after you finish the recording. |
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