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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
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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.): Fill in the blank
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I practice/work in: (select all that apply)
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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
Reference/Academic
Physician Office
Other
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I specialize in: (select all that apply)
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Pediatrics
Family Medicine/Internal Medicine
Laboratory
Emergency Medicine
Urgent Care
Student/Resident
Administration
Pharmacy
Other area of clinical care
Operations/Practice Management
Other
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We currently perform rapid testing for respiratory infectious diseases in the following areas (select all that apply):
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Laboratory
Emergency Room
Pre-surgical Areas
Clinics/Physician Office
Urgent Care
Skilled Nursing/Long Term Care
Pharmacy
Other
None are performed outside the laboratory
Not applicable
Don’t know
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By registering for this webinar, the information you provide will be shared with the webinar’s sponsors 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
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After clicking 'submit', you will be redirected to the
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You will also receive an email with the link to the evaluation
to fill out after you finish the recording. |
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