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CSTE Cardiovascular Disease and Diabetes Consultant Teams

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Welcome to the Online CSTE Consultant Profile Form!

Your input and feedback is appreciated and will make these consultancies truly a network of experts!

BEFORE YOU START:

  • See if your computer can process online forms by completing a sample form I have set up. Go to the Test Form (See below) and complete it.

  • If you get a Thank You Page,
    • Click on to the CSTE Link to return to this Web page.
    • When you have completed this form:
      1. Hit the Submit button;
      2. I will get your responses in an E-mail.

  • If you do not get a Thank You Page,
    • Then your computer is not equipped to process forms.
    • Download the CSTE Survey - Rich Test Version (See below) .
    • Complete this version, and either:
      1. E-mail it back to me as an attachment;
      2. Or, paste the completed survey into the body of an E-mail, and then E-mail it back to me.
Go to Test Form Go to CSTE Survey - Rich Text Version

Goal - To obtain some basic information from CSTE members who are interested in volunteering for the Cardiovascular Disease and/or Diabetes Consultant teams.

Objective - To use this input/feedback to develop super consultant teams that can respond to CSTE leadership requests for our expert input.

Directions - Complete this form using the pull down menus to pick a choice, or write in responses, where appropriate. Once I have had a chance to analyze the responses, I will then develop an electronic mailing of everyone who has volunteered, and through that mailing, everyone will be able to communicate with one another via E-mail. Thank you again for taking the time. Betty

Purpose

I am interested in part of

I am a current CSTE Member

Demographic Information

Title

Name

Suffix

Job Title

Name of Organization

Organization Type

Work Address

Town/City

State

Zip

Phone[Area Code](Work):

Primary E-Mail

Secondary E-Mail

Areas of Expertise

In the area of Cardiovascular Disease, what is your level of expertise in the following areas

  • A. Epidemiological Issues
  • B. Medical Issues
  • C. Policy Issues
  • D. Practice Guideline Issues
  • E. Training/Education Issues
  • F. Other (Describe)
  • F1. Level of expertise for "F. Other"

In the area of Diabetes, what is your level of expertise in the following areas

  • A. Epidemiological Issues
  • B. Medical Issues
  • C. Policy Issues
  • D. Practice Guideline Issues
  • E. Training/Education Issues
  • F. Other (Describe)
  • F1. Level of expertise for "F. Other"

Areas of Interest & Availability

I would be interested in being part of the following Cardiovascular Disease work groups

  • A. Epidemiological Issues
  • B. Medical Issues
  • C. Policy Issues
  • D. Practice Guideline Issues
  • E. Training/Education Issues
  • F. Other (Describe)

I would be interested in being part of the following Diabetes work groups

  • A. Epidemiological Issues
  • B. Medical Issues
  • C. Policy Issues
  • D. Practice Guideline Issues
  • E. Training/Education Issues
  • F. Other (Describe)

I can respond to a request

My availability is

Additional comments, suggestions, whatever, regarding the Cardiovascular Disease Consultant Team.

Additional comments, suggestions, whatever, regarding the Diabetes Consultant Team.

Thank you so much for your help! Betty
Published on the Web: February 12, 2002
UPDATED: December 24, 2007 R23
Comments, suggestions, dead link reports: Betty C. Jung, Webmaster
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