Attendee information form: SDEP® Abdomen Lab Weekend - January 26-28, 2024 | SonoPath

2024 SDEP® Abdomen Lab – January 26-28th – Andover, New Jersey

Email(Required)

First Name(Required)

Last Name(Required)

What state is your license issued in?(Required)

What is your license number?(Required)

*Technicians please put N/A

Professional Code(Required)

(Use the following profession codes for this board: Veterinarian=V; Veterinarian Technician=VT) SELECT FROM DROPDOWN

Veterinary Credentials(Required)

DVM

DACVIM

DACVIM-SAIM

ABVP

DABVP

CVT

LVT

RVT

VMD

ARDMS

RDMS

Technician

APAC

ARF

BSc

BVSc

CCRP

CCRT

CERP

CVA

CVCHM

CVJ

CVPP

DACVO

DACVS

DACVS-SA

DACVSMR

DACVR

DACVP

DAVDC

DDA

ECVIM

HBSc

MBA

MHS

MPH

MRCVS

MSc

NAP

PhD

RPG

Not A Veterinarian

Choose all that apply.

Corporate Affiliation(Required)

Please use NA if you do not have a corporate affiliation.

Company Name(Required)

Address(Required)

City(Required)

State(Required)

Postal Code(Required)

Mobile Phone Number(Required)

Dietary Restrictions?(Required)

This field is used to help accommodate catering decisions for the lab weekend.

If yes, please specify(Required)

Please be specific with any of your restrictions and or allergies.

Do you have an physical limitations that would limit your scanning abilities, that we should know about?(Required)

Example limitations: Carpal tunnel syndrome, shoulder issues, standing for long periods at a time, etc. We ask this, so that we can be prepared for any special accommodations or alternative suggestions for scanning positions that will best accommodate you.

If yes, please specify(Required)

Please be specific with any physical limitation concerns you may have.

Let us know a little bit about you

Are you familar with the SDEP® protocol?(Required)

Yes – I have been scanning with the SDEP® Protocol

No – I do not use the SDEP® protocol

Other

If yes, where did you receive your training?(Required)

Previous Hands on SDEP® Abdomen Lab with SonoPath

Previous LIVE Virtual SDEP® Abdomen Lab with SonoPath

SDEP® Abdomen online course on SonoPath Education Network

Other

Tell us about your current ABDOMINAL ultrasound level so we can tailor our teaching and wetlab stations to your needs.(Required)

I am a beginner – I’ve barely done any scanning

I am intermediate – I get most organs, but have trouble with adrenals and high-end views

I am advanced – I readily get organs, but would like to improve my efficiency on high end views and clinical approach to pathology

Other

What do you hope to achieve from the 3-day SDEP® Abdomen Lab?(Required)

What do you hope to learn from the pathology lectures?(Required)

Do you currently submit cases to a telemedicine company for evaluation?(Required)

We currently use SonoPath for telemedicine

Yes we use another telemedicine company

Would you like to set up a FREE telemedicine account with SonoPath for after lab support and diagnostic reports?(Required)

Does your practice currently have an ultrasound machine?(Required)

Yes

If no, would you be interested in the following:(Required)

I am interested in a free pricing consultation regarding the SonoPath NinjaSP

Other

What brand is your Ultrasound machine?(Required)

SonoPath Ninja SP

Mindray

Esaote

Toshiba

Samsung

Phillips

Hitachi

Fuji

Wisonic

Sonoscape

Other

What model is your ultrasound machine?(Required)

Please use NA if you do not know the model.

Are you looking to upgrade your current ultrasound system?(Required)

Yes

Please select all that apply(Required)

I am interested in learning more about the SonoPath NinjaSP

I am interested in acquiring more probes

I am interested in a pricing consultation regarding the SonoPath NinjaSP

I have other questions

Please list your questions here(Required)

How did you find out about our ultrasound lab?(Required)

Attended a SonoPath weekend lab before

Have taken an online course with SonoPath

Google Search

Facebook

Linked In

I received an email

Dr. Lindquist

A friend or colleague told me about it

Other

If other, please describe here:(Required)

Will you be staying the Courtyard by Marriot Rockaway/Mt. Arlington with our Attendee discount?(Required)

Yes

If staying at the Courtyard, would you like to request a seat on the shuttle (from the Courtyard to the Education Center)? Please keep in mind, space is limited to the first 10 requests. To ensure a reservation please return this survey promptly. You will be contacted either way to confirm your reservation or to be notified that the shuttle is full.(Required)

Yes

Social Media, Video & Photograph Waivers

Please review the permission waivers below for video, recording, photography and usages that may occur during the SDEP® Abdomen Lab weekend 2024. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

Social Media, Video & Photograph Waivers:(Required)

YES: 1. I hereby give SonoPath, LLC the absolute right and permission to publish images/pictures of me for promotional purposes in which I may be included in whole or in part. 2. I hereby also grant permission to the rights of my image and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed. 3. By checking this box I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet.

NO: I do not grant SonoPath, LLC the right or permission to publish images/pictures/recordings of me for promotional purposes in which I may be included in whole or in part.

Permission Waiver: Digital Signature:(Required)

By checking the boxes above and typing my name in this field, I acknowledge that I have completely read and fully understand the releases and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

SonoPath, LLC – Intellectual Property Statement:(Required)

YES: I agree to the intellectual property statement below.

NO: I have questions

INTELLECTUAL PROPERTY STATEMENT: The content of this course, video and procedures are protected under copyright and other intellectual property laws. Video’s supplied to the attendees and/or education information is ONLY for non-commercial private viewing and individual private use only. Any distribution, sharing, copying, teaching, transmission, public performance, alteration, or reverse engineering outside private individual use of purchaser/attendees (unless expressly authorized by SonoPath, LLC) is strictly prohibited and may result in criminal and or civil liability.

If you answered no, please list your questions here:(Required)

Intellectual Property Statement: Digital signature(Required)

By checking the YES box above and typing my full name in this field, I acknowledge that I have completely read and fully understand the intellectual property statement and agree to be bound thereby.

Anything else you would like to let us know? Any Questions?

Attendee information form: SDEP® Abdomen Lab Weekend – January 26-28, 2024

2024 SDEP® Abdomen Lab – January 26-28th – Andover, New Jersey

Let us know a little bit about you

Social Media, Video & Photograph Waivers