Surgeon Performance Program - Interest Form
Complete this form in order to be considered eligible for the Surgeon Performance Program. This program is sponsored by the Setting Scoliosis Straight Foundation. We appreciate your support and interest.
Institution and/or Location
How did you first hear about the Surgeon Performance Program?
Setting Scoliosis Straight website
Surgeon already participating in the program
Exhibit at a conference
Why are you interested in the program?
I want to track my surgical cases.
I'm interested in improving my surgical outcomes.
I want to see how I'm doing compared to my peers.
I'm interested in attending and contributing to surgeon education events.
Surgeons I know are participating.
Participants, colleagues, and others have recommended this program.
Using the scale, gauge your willingness to interact with IRBs or any appropriate persons and departments to be allowed to participate in the program.
Do you currently perform more than 10 Adolescent Idiopathic Scoliosis (AIS) surgeries each year?
Are you willing to enter consecutive AIS cases throughout the year?
If you participate in the program, who will enter your patient data?
I will enter patient data.
My delegate (research coordinator, assistant, nurse, etc.) will enter patient data.
Both my delegate and I will enter patient data.
Do you have additional comments?
Send me a copy of my responses.
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