Community Focus Group Registration

Thank you for your interest in participating in a community focus group in your region.  Please complete the form below to register for a session in your area.  Registration is limited at each location.  If your chosen site is full, you will be notified and given the option to be put on a cancellation list.

Name *
Please select the option that best suits your current practice setting. For 'Other', please use the comment box below to describe your practice setting.
Please select the option below that best describes your patient population