First Name

Last Name

Email

Phone

Residency Year PGY1 PGY2 PGY3 PGY4 PGY5 PGY6 Fellowship

NPI

Academic training program affiliation

Do you have exposure to Aquablation therapy today? If yes, what hospital?

In what year will you complete residency/fellowship training and enter independent practice?

What type of training with Aquablation therapy are you interested in? Online Education In Person Training All of the above

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