Pre-Conference Survey

Full Name*

First Last

Email*

INA Username

If you are an INA Member, please enter your username below.

Country of Origin

What is your professional status?*

Physician
Scientist
Other

Please specify your professional status*

What is your specialty focus?*

Please specify your specialty focus*

Number of years in practice/research:*

Type of Practice:*

Please specify type of practice*

What clinical condition(s) do you treat with botulinum toxin (check all that apply)*

Movement disorders
Adult Spasticity
Pediatric Spasticity
Dermatologic Disorders /Aesthetic Problems
Chronic Migraine/Headache
Other
Not Applicable

Please specify clinical condition(s)*

Which type of localization/guidance do you utilize (check all that apply)*

EMG
E-stim
Ultrasound
Other
Not applicable

Please specify localization/guidance*

Please list at least one learning goal for yourself prior to this conference

If achieved, this goal will address a gap in (check all that apply):

Knowledge
Competence
Practice
Patient health

Self-Assessment

Please rank your current ability to:

Review the mechanisms of action and pharmacology of various botulinum neurotoxin serotypes and preparations, in order to understand their therapeutic effect

Evaluate clinical data, evidence-based recommendations, and practical experience in the use of botulinum neurotoxins for multiple and diverse clinical conditions, in order to properly assess and select appropriate patients for neurotoxin therapy

Demonstrate best practice procedures and techniques for neurotoxin injections, in order to improve clinical skills and optimize patient outcomes in a wide range of clinical disorders

Identify the most up-to-date scientific and clinical research, in order to enhance understanding of the science and clinical utility of neurotoxins

Promote interaction and cooperation among a wide range of scientific and clinical disciplines, in order to advance research and education relevant to the science and therapeutic application of botulinum and other neurotoxins

Clinicians (if applicable)

What aspects of the clinical application of botulinum toxin in your practice do you most hope will be improved by this activity? (Please select all that apply)

General principles of BoNT therapy
Condition-specific patient selection
Procedures for administering BoNT therapy
Condition-specific injection technique, including injection site and/or muscle selection and dosing of BoNT
Post-injection patient management
Not applicable

Basic Scientists (if applicable)

What aspects of your knowledge of BoNT science and theory do you most hope will be improved by this activity? (Please select all that apply)

BoNT pharmacology
Mechanism of action of BoNTs
Structure of BoNTs
Central nervous system effects of BoNTs
Emerging BoNT research
Not applicable

What is the most important thing you would like to learn at this conference?

Self-Assessment

Clinicians (if applicable)

Basic Scientists (if applicable)

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