PMP Toolkit Registration Form Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Email Address Question Title * 4. Practice Name Question Title * 5. Practice Address Street City Zip Code Question Title * 6. What is your credential? MD DO DNP NP PA Other (please specify) Question Title * 7. What is your specialty? General Pediatrics Family Medicine Other (please specify) Question Title * 8. Which of the following is the best description of your practice? Solo practice Group practice Hospital-owned Federally Qualified Health Center (FQHC) Academic Health Center Other (please specify) Question Title * 9. Have you participated in PMP activities/used PMP resources in the past? Yes, I participated in the PMP QI program Yes, I attended a PMP training Yes, I have used PMP resources No Other (please specify) Question Title * 10. How did you learn about the toolkit? (Select all that apply) Ohio AAP Today newsletter Personal email from Ohio AAP Personal phone call from Ohio AAP Other Ohio AAP email Ohio AAP Annual Meeting Ohio AAP live webinar/training Ohio AAP podcast Ohio AAP Facebook Ohio AAP Instagram Ohio AAP Twitter Ohio AAP LinkedIn Ohio Association of Community Health Centers listserv or social media Ohio Association of Physician Assistants listserv or social media Ohio Association of Advanced Practice Nurses listserv or social media Ohio Osteopathic Association listserv or social media Word of mouth (e.g., colleague, friend, patient/family) Other (please specify) Question Title * 11. What are your top 1-2 reasons for requesting the PMP toolkit? Done