Skip to content
In-Hospital Pre-Training Survey -Abdomen
In-Hospital Training – Abdomen : Pre-event Information Survey
Email
(Required)
First Name
(Required)
Last Name
(Required)
What state is your license issued in?
(Required)
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UM
UT
VA
VI
VT
WA
WI
WV
WY
International/Other
What is your license number?
(Required)
*Assistants please put N/A
Professional Code
(Required)
V
VT
N/A
(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
AH
APAC
ARF
BS
BSc
BVSc
CCRP
CCRT
CERP
CVA
CVCHM
CVJ
CVPP
DACVO
DACVS
DACVS-SA
DACVSMR
DACVR
DACVP
DAVDC
DDA
ECVIM
HBSc
JD
MBA
MHS
MPH
MRCVS
MS
MSc
NAP
PhD
PT
RPG
BVM&S
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)
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UM
UT
VA
VI
VT
WA
WI
WV
WY
International/Other
Postal Code
(Required)
Mobile Phone Number
(Required)
Do you have an physical limitations that would limit your scanning abilities, that we should know about?
(Required)
No
Yes
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
Only from watching the training materials
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 instruction to your needs.
(Required)
I am a beginner – I’ve done little to no 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, shunt hunts, and ability to adapt to all situations.
Other
How many ultrasounds do you currently perform each week?
(Required)
0
1-5
6-10
>10
Do you have any echocardiogram experience?
(Required)
Yes
No
NOTE: Abdominal video series touches base with Echo SDEP® pos 3.
What do you hope to achieve from your In-Hospital Training and going forward? Please be as specific as you can; the more we know the more we can assist in your goals.
(Required)
Do you currently submit cases to a telemedicine company for evaluation?
(Required)
We currently use SonoPath for telemedicine.
We plan to use SonoPath after training.
No.
What make and model of ultrasound machine does your practice currently have? How old is it?
(Required)
Are you looking to upgrade your current ultrasound system?
(Required)
Yes
No
Would you be interested in the following:
(Required)
I am interested in a free pricing consultation regarding the M11 (exclusively distributed in North America by SonoPath)
Other
Please list your questions here
(Required)
How did you find out about our In-Hospital Training opportunity?
(Required)
Previous attendee of SonoPath Lab Weekend
Online Courses with SonoPath
Google Search
Facebook
LinkedIn
Marketing Email from SonoPath
Dr. Lindquist
A friend or colleague told me about it
Other
If other, please describe here:
(Required)
Social Media, Video & Photograph Waivers
Please review the permission waivers below for video, recording, photography and usages that may occur during the In-Hospital Training. 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?
Δ
