JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Prone Positioning Course
Registration Form
(Your feedback may be used for publicity material)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email Address
*
Your answer
Gender
*
Female
Male
Required
Full Name
*
Your answer
How did you first learn about the course?
*
Facebook
Twitter
Google search
AKU website
Word of Mouth (Friend or Acquaintance Referral)
Email
WhatsApp
Instagram
Other:
Basic Qualification
*
Your answer
Postgraduate Education
*
Your answer
Specialty
*
Internal Medicine
Anesthesiology
Critical Care/Intensive Care
Physiotherapy
Cardiology
Pulmonology
Pediatrics
Family Medicine
Emergency Medicine
Other:
Years of experience in the medical field
*
Your answer
Designation / Title
*
Medical Officer
Professor/Consultant Physician
House Officer/Intern
Trainee/Post Graduate Trainee
Physiotherapist
Technologist/Technician
Registrar
Nurse
Medical student
Nursing student
Other:
Do you currently work or plan to work in ICU/HDU?
*
Yes
No
Name of Institution/Department (Affiliation)
*
Your answer
Type of Institution
*
Federal Government
Provincial Government
City Government
Private
Semi-Private
Charitable/Trust
Other:
City
*
Your answer
Province
*
Sindh
Punjab
KPK
Balochistan
Other:
Contact No (Please provide the number that is active on WhatsApp)
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
