“Mommy, be my doctor” Personalization Questionnaire

"Mommy, be my doctor" Participant Questionnaire

My goal of this course is to be as tailored to your specific and current needs as possible, within my scope of teaching. In order for me to better facilitate all members of this workshop, please answer the following as detailed as possible and submit this form to me as soon as possible.

How educated are you on the topic of anatomy and pathophysiology? ("Not at all educated on this topic" is perfectly fine. You're still in the right class). *
Are you willing to share your situation out loud in class for us to use your specific circumstances to teach the class to overcome similar circumstances? *
This class will be taped and used for further teaching. Do I have permission to share the tape of you exclusively for educational purposes? *