JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
1 Day Injection Therapy Workshop for Medical and Podiatric Practitioners.
Location: Various
Cost: AUD$1495
Time: 8.30am arrival - 5pm finish
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Clinic name & address
*
Your answer
Phone number
*
Your answer
Preferred date of workshop ?
*
I'm interested in attending a workshop in the future. Please add me to email list
Feb 21 Noosaville
Required
Dietary restrictions
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
Participants may have an opportunity to perform and receive injections ( LA, glucose and/or saline) as a part of this training. Please indicate if you do not wish to receive injections.
Yes, i consent to receiving injections
No, I would prefer not to receive injections
Other:
Clear selection
Please indicate if you have any current lower limb MSK conditions that you would be open to receiving injections on the day.
Yes i have a condition and iI'm open to receiving Rx
No
N/A
Clear selection
Level of injection experience?
Your answer
I understand that I will have to pay the entire workshop fee to secure your place.
*
Yes
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report