Pre-Consultation Questions for Breast Ultrasound Training

This form must be filled out prior to your consultation. Please email info@mammographyeducators.com if you have any questions.

Facility or Hospital (where the training will be held)*
Is your facility part of a larger organization? If so, please indicate below. If not, put N/A:*
Facility Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please list next date(s) of accreditation for each breast ultrasound unit at your facility. (List unit number and corresponding due date in MM/DD/YY format)*
Please provide the contact information of your accounts payable department or whomever processes your invoices. Please list name, phone and e-mail below.*
Please provide any parking instructions or directions to the building (if applicable) that the consultant should be aware of*
Are there any visitor or vendor requirements that your consultant will need to complete prior to training, such as: sign-in processes, documentation or verification requirements, etc? Please provide specific details, if applicable.*
Name of the individual who will be meeting the consultant on the first day of training*
First Last
What is the best contact number for the individual listed above?*
What is the first name, last name, and credentials for the sonographer(s) participating in the training?*
The consultant will be bringing a lecture presentation on a USB flash drive. Is a USB flash drive compatible with your computer/projector system? (Please confirm with your IT Department)*
Please enter any additional information we should know:
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