Demographic Questions - Webcast Part II

Sudden Cardiac Death (SCD) Risk Assessment


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Step 1 of 3

     
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Date:

   
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First Name:

   
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Last Name:

   
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E-mail:

   
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Mailing Address:

   
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City:

   
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State:

   
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Zip:

   
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What is the best way to reach you for the post activity questionnaire?

   
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What is your degree?

   
 

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What is your specialty focus?

 

 
 

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Number of years in practice

   
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Type of practice

   
 

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Do you consider your practice to be primarily...

   
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Practice name and/or hospital affiliation

 
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Approximate percentage of patients you manage for the disease/s addressed by this activity?

   
 

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