Polio Australia: FREE Clinical Workshop Request Form
On behalf of your local people who are polio-affected, who depend on informed local healthcare professionals and workers, thank you for choosing to host one of Polio Australia's clinical workshops for your staff! It is through these workshops that we reduce the frustration and risks that polio survivors endure as a part of their condition and society's misperceptions.

All health professionals can submit participating CPD hours to their peak body for CPD credit. A personalised course certificate is provided to attendees for free upon quiz completion for sessions of of 60min or longer.
 
If you wish to schedule MORE THAN ONE workshop on a particular day (or a few workshops over several days), please fill this form out ONCE, and then explain in the COMMENTS section how and when the additional workshops will be scheduled.

COVID-safe practices: We abide primarily by the state and clinic/facility procedures that are in place at the time, and enact (as a minimum) our own workshop COVID-safe plan for other venues (i.e. non-health community venues).

Should you have any questions about this form, please email: michael@polioaustralia.org.au or call 0466 719 013. This form has been submitted over 100 times by hosts to schedule workshops. Word version is available on request if you cannot submit this form.
Sign in to Google to save your progress. Learn more
State or Territory *
Location Type *
City or Town or Suburb *
Facility Name *
Department Name (optional)
Specific building or room or venue name (optional)
Estimated capacity of the venue *
We have a COVID-safe plan for our location *
Address the workshop will be held at *
Contact person (site host) name *
Contact person phone number *
Contact person email *
Audience for the workshop *
Required
Preferred date *
Click on the date if there is a calendar icon. Date appears in the US format of mm/dd/yyyy.
MM
/
DD
/
YYYY
Alternative Date (optional)
MM
/
DD
/
YYYY
Preferred start time for workshop
Time
:
Duration of time allocated or requested for the workshop *
Our allied health CPD workshop covers the minimal pertinent information in 60-90 min. With a 90 to 120 min length workshop (ideal) we can go more in depth and also have a local polio survivor share their lived experience. We are flexible with medical office information sessions, these work best at 30-45 minutes length.
This workshop will be... *
Post-Workshop certificates and pdfs *
Within a week of the workshop, attendee certificates and pdfs are distributed to the attendees. There are a few ways this can be done, depending on your facility or education program. Shorter information sessions (<1 hour) are not issued CPD certificates.
The workshop requires audiovisual (AV) equipment for the presentation aspects of the workshop. How would you generally describe the equipment you have at the venue and it's availability? *
(We are able to bring our projector if your location does not have one.)
The workshop (if 1.5-2hrs duration) has a polio survivor from the local area attend . Many polio survivors use wheeled assistive technology. Are there any barriers to physical accessibility for a survivor to be aware of? *
We automatically add your clinic or department where the training took place to our Professional Registry (see here https://www.poliohealth.org.au/search-health-professionals-register/ ). This enables local survivors to find you, other clinicians to refer survivors to you, and you to find other LEoP informed clinicians.
 *
Do you have any other information which may be useful for us to know about hosting a workshop in your location?
e.g. parking, local construction affecting access, if you have polio-affected clients who might like to share their story at the session, alternative contact on the day.
Other comments or preferences
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Polio Australia Incorporated. Report Abuse
Google Forms