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.
Email address *
First Name *
Your answer
Last Name *
Your answer
Institution and/or Location *
Your answer
How did you first hear about the Surgeon Performance Program? *
Why are you interested in the 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. *
Not willing
Very willing
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? *
Do you have additional comments?
Your answer
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