2025 PIV Curriculum Interest Hospitals, Clinicians and Individuals

PIV Curriculum Information Form (Hospitals, Clinicians and Individuals)

Please complete this form if you would like to be informed regarding the rollout of the upcoming PIV Curriculum/Courses. We have developed curriculum for practicing clinicians and healthcare facilities. Currently, this is only available in English.
Primary Contact*

First NameLast Name
E-mail address (by submitting your email address, you give the Association for Vascular Access and/or B. Braun Medical Inc., to contact you)*
example@example.com
Phone Number*
Your current position*

Hospital Administrator/supervisorPracticing clinicianStudentOther
If selecting "other" please elaborate:
Which license do you hold?*

Nursing and/or Nurse PractitionerMedicine and/or Physician AssistantRespiratory TherapyRadiology TechnicianVeterinaryDentistOther
How soon would you like to implement the curriculum?

As soon as possible1st quarter 20252nd quarter 20253rd quarter 20254th quarter 2025Just looking for information at this time.
Name of Hospital or facility (No Acronyms please)*
If not in a facility, type N/A
Location*

CityState / Province
Postal /Zip Code*
Country
Please indicate your primary reasons for interest in the PIV Curriculum:*
Request for

Hospital/InstitutionIndividual/Self
How did you hear about this program?*

AVA Website or Social MediaB BraunPress ReleaseYour InstitutionAnother Association other than AVAOther
If you heard of this from another Association or "other" please clarify
Are you interested in hearing about our Ultrasound Guided PIV Insertion Education?

YesNo
I give my permission to SJC Vascular Access, and B. Braun Medical Inc. to contact me.*

NoYes
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PIV Curriculum Information Form (Hospitals, Clinicians and Individuals)