Disability Friendly Provider DFP Workshop Registration Form

Disability-friendly Health Provider Workshop

Each individual person participating must submit a registeration
Each individual person attending must register.
Thank you so much for your interest in joining disABILITYsa in our efforts to break down the barriers that may inhibit individuals living with various disabilities from seeking care at local pharmacies and clinics. Through our Disability-friendly Provider Workshop, participants can increase their knowledge on how to easily make a healthcare environment more disability-friendly.

Each individual person attending must complete the registration form below. Thank you.

The San Antonio Metro Health District designates this live activity for 3.00 credits of education in medical ethics and/or professional responsibility.

CME: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Texas Medical Association (TMA) through the joint providership of San Antonio Metro Health and disABILITYsa. The San Antonio Metro Health District is accredited by TMA to provide continuing medical education for physicians.

CNE: San Antonio Metro Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Alamo Colleges designates this live activity for 3.5 general CEU's. This benefit is NOT currently available.

CEU: Continuing Education Units
Name*

First NameLast Name
Title*
Hospital/Clinic AdministratorOther AdministrationPhysicianPharmacistNurse (RN/LVN)ClinicianTechnicianCommunity Health WorkerDentistStudentOther
Please Describe:*
Sessions will take place in the Fiesta Room at AACOG | 2700 NE Interstate 410 Loop , San Antonio, TX 78217.

A light meal consisting of tuna salad, chicken salad, and pasta salad will be provided.
July 11th, 2025 11:30am-3:00pmSeptember 23rd, 2025 5:00pm-8:30pmDecember 12th, 2025 11:30am-3:00pm
You've selected a date that has passed. Please select an alternate date in the section above. Thank you!
July 11th, 2025 11:30am-3:00pmSeptember 23rd, 2025 5:00pm-8:30pmDecember 5th, 2025 11:30am-3:00pm
Total # of Staff at your pharmacy/clinic/ office?*
YesNo
Hospital/Provider/Clinic/Pharmacy Name:*
Physical Pharmacy/Clinic Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Cell Phone Number
To receive text updatesFormat: (000) 000-0000.

Registration Options*

General Registration

Individual Workshop Registration [FREE]

$ Free

3.5 CEUs (Continuing Education Units)

$ Free

3.0 CNE (Continuing Nursing Education)

$ Free

3.0 CME (Continuing Medical Education)

$ Free

Disability-friendly Starter Kit

Includes: Buzzy, DisatrACTION Cards, Shotblocker, Weighted Blanket, Bubble Machine, Noise Cancelling Earmuffs, Dexterity Support Pen Holder, Signature Guide, Magnifying Glass, Fidgets, Communication Boards, Guide Book, Countertop Support Decal, and more in a storage Container.

$325.00

Donation to help cover the costs of this workshop

$10.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Cell Phone Number*
Please enter a valid phone number where you can be reached via text message.Format: (000) 000-0000.
Should be Empty:

Disability-friendly Health Provider Workshop