MTM Web-Based Training Completion

We need some important information from you so that we may update your access to include MTM.

Question Title

* 1. Please complete your contact information

Last name *

First name *

Department *

Division *

Email Address:

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* 2. Please complete the contact information of the physician for whom you work

First name

Last name

Department

Division

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* 3. What is your role?

Medical Secretary

Secretary

Administrative Assistant

Other (please specify)

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* 4. Did you complete all of the MTM training modules?

Yes

No

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