AO North America

Maxillofacial Pre-Course Questionnaire

This must be completed for registration form to be processed.

HOW MANY YEARS IN PRACTICE?:

or

PGY:

HOSPITAL/UNIVERSITY AFFILIATION:

PRIVATE PRACTICE:

OTHER:

HAVE YOU ATTENDED A PREVIOUS DISTRACTION COURSE?:

ARE YOU CURRENTLY USING DISTRACTION OSTEOGENESIS?:
YES
NO

IF YES, FOR WHAT PROCEDURES?:

SPECIALTY TRAINING?:

WHAT DO YOU EXPECT TO LEARN THAT WOULD BENEFIT YOU IN YOUR PRACTICE?
PLEASE EXPLAIN IN AS MUCH DETAIL AS POSSIBLE:

Press this button to submit your request:

Thank you for your interest!