Thyroid Interest Group Sign Up
Thank you for your interest in the Thyroid Interest Group. Please supply us with the following demographics.
Name:
Company:
Address:
City:
State:
Country:
: Zip:
Phone:
Fax:
Contact:
Email:
Web Site:
How many years have you been in practice ? :
Please check all that apply to your practice ? :
Private Practice:
, Academic Medicine:
, Solo Practice:
, Group Practice:
,
Hospital Based:
, Other:
What is the spectrum of your practice?
How many thyroid patients do you see in a day ?
How many total patients do you see in a day ?
Please check what other ancilary service are provided by you in your office:
Thyroid Ultrasound |
Fine Needle Aspiration |
Clinical Lab |
Nuclear Medicine
Please check the following meeting you have attended:
AACE Thyroid Ultrasound Certification
AACE Advances in Utrasound
AACE Nuclear Medicine Certification
AACE Endocrine University
Please check if you are a member of the American Thyroid Association :