Medical Committee Meeting Feedback Collection Form

Please help us as we work to re-establish a monthly meeting time for the ACU Medical Committee. If you plan on continuing with this working group, please fill out the following form.

The current established meeting time is the final Monday of each month at 1PM.

Name

First Name

Last Name

Phone

(###)

###

####

Please choose one of the following.

I'm happy to keep the meeting time the same.

I would consider other options.

I have no preference.

If you are unavailable for the current meeting time, please describe your availability: