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myCasereview Registration 2019 with Payment

Demographic Information

myCasereview Registration Form

Thank you for your interest in myCasereview, a program of Midwest Regional Medical Academy. Please complete this survey so that we may enroll you. Your answers will be used to determine your eligibility to participate. Your answers also may be used for quality improvement assessment; if so, your identity will remain anonymous. This survey should take no more than 10 minutes to complete. 

Please note: This program is based on an annual subscription that runs from January-December each calendar year.

This registration form should only be completed by the medical professional intending to use this program.

Disclaimer: myCasereview is a service to make child sexual abuse expertise available to all Child Advocacy Center medical providers regardless of location. The service is designed to provide reviews by an expert for educational purposes and is not intended to be used for initial diagnostic or treatment purposes or to serve as a second opinion for a specific case. This service is not a replacement for a consultation or to address issues related to a specific patient.
1. Please complete the following demographic information: *This question is required.
2. Are you affiliated and/or provide exams for a Children's Advocacy Center through a formal linkage agreement, contract or employment? *This question is required.
4. How did you hear about myCasereview? (select all that apply)
5. What are your reasons for joining myCasereview? Check all that apply.