Healthcare Summit Interest Survey Form
Share your interest and preferences for the Healthcare Summit. Your feedback will help us shape an engaging and relevant event.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Organization / Affiliation
What is your primary role in healthcare?
*
Clinician
Administrator
Researcher
Student
Industry Professional
Other
Which topics are you most interested in for the summit? (Select all that apply)
*
Healthcare Innovation
Digital Health
Patient Experience
Policy & Regulation
Clinical Best Practices
Other
How likely are you to attend the Healthcare Summit?
*
Not Likely
1
2
3
4
Very Likely
5
1 is Not Likely, 5 is Very Likely
Preferred event format
*
In-Person
Virtual
Hybrid
Please rate your overall interest in the Healthcare Summit
*
1
2
3
4
5
Please indicate your interest in the following summit features
Rows
Not Interested
Somewhat Interested
Very Interested
Workshops
1
2
3
Networking Sessions
4
5
6
Keynote Speeches
7
8
9
Panel Discussions
10
11
12
Any additional comments or suggestions?
Submit
Should be Empty: