PulseConnect Registration

PulseConnect Registration
Name*

First NameLast Name
Email*
example@example.com
Company*
Professional Title*
Address Type*
Address*
Please indicate your license titles:*

CDCESCMACNMDODTRLDNLPNMDMPHNDMSNPPAPhDPharmDRD/RDN/LDN/CDNRNRPhOther
Which best describes your primary specialty?*
Which best describes your secondary specialty?*
Which best describes your primary work setting?*
If other, please specify:
How many people do you counsel, coach or advise per week?*
On which of the following topics do you regularly counsel patients or clients?*

AllergiesDiabetesDigestive HealthFitness and ExerciseHeart HealthImmune HealthNutritionNutritional SupplementsPediatricsSenior HealthWeight Management/ObesityWomen's HealthNone of the above
Which of the following do you use for your professional work and/or to share health and wellness information?*

FacebookInstagramX/TwitterTikTokBlogLocal TVLocal NewspaperLinkedInNone of the above
What percentage of your patients or clients are Spanish-only speakers/readers?*
Intervals of 5%
What percentage of your patients or clients qualify for/are on WIC?
Intervals of 5%
How do you see patients?*

In personVirtuallyBoth in person & virtually
Should be Empty: