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Submission: On January 25 via manual from US — Scanned from CA
Submission: On January 25 via manual from US — Scanned from CA
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<h1 class="sg-title" tabindex="0"><span>Registration Form - Masterclass Series: Use of Ultrasound for Chemodenervation - February 7</span></h1>
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<h2 class="sg-page-title" role="heading" tabindex="0">Evidence-based Presentation and Live Web Demo: Use of Ultrasound in Chemodenervation in Cervical Dystonia</h2>
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<strong><span style="font-size:18px;">Join our lead facilitators:<br> Mandar Jog, MD, FRCP<br> Omar Khan, MD, FRCPC<br> Rajiv Reebye, MD, FRCPC</span></strong><br><br><span style="font-size:12pt;"><span><span
style="color:#e22424;"><strong><u><span lang="en-us" style="font-size:13pt;" xml:lang="en-us">WHEN:</span></u> </strong></span><span style="color:#000000;"><strong><span lang="en-us" style="font-size:13pt;"
xml:lang="en-us">Tuesday, February 7, 2023 - 6:15pm - 9:00pm (EST) / 3:15pm - 6:00pm (PST)</span></strong></span></span></span><br><span style="font-size:12pt;"><span
style="color:#e22424;"><strong><u><span lang="en-us" style="font-size:13pt;" xml:lang="en-us">WHERE:</span></u></strong></span><span style="color:#2980b9;"><span lang="en-us" style="font-size:13pt;" xml:lang="en-us">
</span></span><span style="color:#000000;"><span lang="en-us" style="font-size:13pt;" xml:lang="en-us">Virtual Platform (Zoom and
REACTS)</span><b><span lang="en-us" style="font-size:13pt;" xml:lang="en-us"> </span></b></span></span><br><br><span style="font-size:16px;"><span style="color:#000000;"><span lang="en-us" xml:lang="en-us">The purpose of this
<b>Masterclass Series</b> is to bring together neurotoxin injectors in the field of Cervical Dystonia and to provide a forum for learning and the exchange of best practices with respect to cervical dystonia management in an
interdisciplinary team setting. </span></span><br><br><span style="color:#000000;"><span lang="en-us" xml:lang="en-us">In</span></span> the first hour, there will be a focus on the evidence in the use of ultrasound guidance for
neurotoxin injection. The rest of the masterclass, live web demo: use of ultrasound in chemodenervation in cervical dystonia will focus on reviewing practical aspects of treatment.<br><br> Dr. Mandar Jog, Dr. Omar Khan and Dr. Rajiv
Reebye will be co-facilitating this virtual course.</span><br> <div class="Default" style="margin-top:0in;margin-right:0in;margin-bottom:.65pt;text-align:justify;margin:0in;"><span> </span><br><span
style="font-size:12pt;"><span style="color:#000000;"><b><span lang="en-us" xml:lang="en-us"><span style="color:#e22424;">ONE-ON-ONE 2-HOUR FOLLOW UP SESSION:<span> </span> </span></span></b></span></span><br><span
style="font-size:16px;"><span style="color:#000000;"><span lang="en-us" xml:lang="en-us">Note that participant with an ultrasound machine (purchased or borrowed) will have the opportunity to have One-on-One (2 hour) follow up
sessions post training.</span></span></span><br> </div>
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<span style="color:#e22424;"><strong><span style="font-size:20px;">Registration </span></strong><br> To register, please provide the following information:</span>
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<label for="sgE-50170759-1-5-element"> First Name and Last Name: <strong class="sg-required-icon">*<span class="sg-screenreader-only">This question is required.</span></strong> </label>
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<span class="sg-question-number">1.</span> City <strong class="sg-required-icon">*<span class="sg-screenreader-only">This question is required.</span></strong> </label>
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<span class="sg-question-number">2.</span> Province <strong class="sg-required-icon">*<span class="sg-screenreader-only">This question is required.</span></strong> </label>
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<label for="sgE-50170759-1-7-element"> Specialty <strong class="sg-required-icon">*<span class="sg-screenreader-only">This question is required.</span></strong> </label>
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<span class="sg-question-number">3.</span> What is the number of cervical dystonia patients you are treating on a monthly basis? <strong class="sg-required-icon">*<span class="sg-screenreader-only">This question is
required.</span></strong> </label>
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<span class="sg-question-number">4.</span> How comfortable are you identifying the key muscles for cervical dystonia treatment using the ultrasound? <br> Please rate your level of comfort: <strong
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<span class="sg-question-number">5.</span> Do you use ultrasound guided BoNT-A injections for treatment of cervical dystonia? <strong class="sg-required-icon">*<span class="sg-screenreader-only">This question is required.</span></strong>
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<span class="sg-question-number">6.</span> How confident are you using ultrasound for BNT-A injection guidance for cervical dystonia?<br> Please rate your level of confidence: <strong class="sg-required-icon">*<span
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We've detected that Javascript is not enabled. It is required for an optimal survey taking experience. Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript. Skip survey header REGISTRATION FORM - MASTERCLASS SERIES: USE OF ULTRASOUND FOR CHEMODENERVATION - FEBRUARY 7 EVIDENCE-BASED PRESENTATION AND LIVE WEB DEMO: USE OF ULTRASOUND IN CHEMODENERVATION IN CERVICAL DYSTONIA Join our lead facilitators: Mandar Jog, MD, FRCP Omar Khan, MD, FRCPC Rajiv Reebye, MD, FRCPC WHEN: Tuesday, February 7, 2023 - 6:15pm - 9:00pm (EST) / 3:15pm - 6:00pm (PST) WHERE: Virtual Platform (Zoom and REACTS) The purpose of this Masterclass Series is to bring together neurotoxin injectors in the field of Cervical Dystonia and to provide a forum for learning and the exchange of best practices with respect to cervical dystonia management in an interdisciplinary team setting. In the first hour, there will be a focus on the evidence in the use of ultrasound guidance for neurotoxin injection. The rest of the masterclass, live web demo: use of ultrasound in chemodenervation in cervical dystonia will focus on reviewing practical aspects of treatment. Dr. Mandar Jog, Dr. Omar Khan and Dr. Rajiv Reebye will be co-facilitating this virtual course. ONE-ON-ONE 2-HOUR FOLLOW UP SESSION: Note that participant with an ultrasound machine (purchased or borrowed) will have the opportunity to have One-on-One (2 hour) follow up sessions post training. Registration To register, please provide the following information: First Name and Last Name: *This question is required. Email address *This question is required. This question requires a valid email address. 1. City *This question is required. 2. Province *This question is required. Specialty *This question is required. 3. What is the number of cervical dystonia patients you are treating on a monthly basis? *This question is required. 4. How comfortable are you identifying the key muscles for cervical dystonia treatment using the ultrasound? Please rate your level of comfort: *This question is required. Not comfortable Neutral Very comfortable 5. Do you use ultrasound guided BoNT-A injections for treatment of cervical dystonia? *This question is required. * Yes * No 6. How confident are you using ultrasound for BNT-A injection guidance for cervical dystonia? Please rate your level of confidence: *This question is required. Not confident Neutral Very confident 0%