MPS Request for Certificate, Course Evaluation and Quiz

First Name*

Last Name*

Occupation (PT, PTA, OT, OTA, LMT, etc.)*

License #

Email (We only send MPS info)*

Course Type, Location & Date*

Instructor*

MPS COURSE EVALUATION

Course material was clear and easy to understand.*

Meeting room was conducive to learning.*

MPS treatments witnessed or received were beneficial.*

Trainer effectively presented the material.*

My patients/clients will benefit from MPS Therapy.*

Overall, I enjoyed the course and found it educational.*

Positive feedback on course or treatments:

Any negative feedback?

Can we use positive feedback (as indicated above) for marketing purposes?

REFERRALS WE SHOULD CONTACT ABOUT MPS COURSES

Yes, I would like to refer people to MPS courses. Please email me.

YOUR PRACTICE

I plan to incorporate MPS into my practice or already use it.

List me in the MPS Practitioner Directory so potential clients can find me.

If yes, we will email you a link to create your practitioner profile.

Title