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Greetings Therapists,

Below is a Needs Assessment Survey that will take only a few moments to fill out. We would like to hear your feedback on what kind of workshops you are interested in taking, along with some additional information. Fill out the survey, be sure to include your email address and receive $20.00 off your next Workshop! Once we have the completed survey back, you will receive a confirmation email that will contain your workshop discount.

Instructions:

Please fill out the survey and click the "Submit" button at the bottom of the email. When your information has been received successfully, you will be sent to a confirmation page. We thank you in advance for your participation, and we look forward to seeing you at a workshop!

MTN Customer Care

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MTN NEEDS ASSESSMENT

For Therapists

1. Gender: male    female

My age is :

My profession is (include license, if applicable):

Optional:

I've been working as a (job title):

for (Organization/firm):

for (length of time):

2. What do you want out of a CONTINUING EDUCATION/ TRAINING workshop?:

3. What topics would you want CONTINUING EDUCATION/TRAINING workshop exercises to cover?   (indicate all that applies and rank with best=1)

Online Certification:   

Life Coaching:           

Yoga For Therapists, I: 

Yoga For Therapists, II:

Law and Ethics:          

Yoga/Stress Management: 

Me, Myself, & Yoga:      

Crisis Debriefing:      

Coaching For Personal Growth:           

Negotiation/Conflict Resolution Skills:

Enhancing Diversity and Conflict Management Skills for Therapists:

Team Building During Turbulent Times:       

Creating Work-life Balance:                 

Enhance Personal Wellness to Avoid Burnout:

Rejuvenate Your Practice and Yourself: Survival Skills for Therapists:

Other Training/CEU workshops you would be interested in taking:

4. What challenges at your work are related to the CONTINUINGEDUCATION/TRAINING topics that you picked in question # 3?:

5. What length of CONTINUING EDUCATION/TRAINING workshop would you attend? (indicate all that applies and rank 1-5, with best=1)

1.5 hours:

3 hours:   

6 hours:   

2 days:    

3 days:    

other (longer):

6. What time of the year would be best for you to attend a CONTINUING

EDUCATION/TRAINING workshop? (rank 1-4, with best=1)

fall:   

winter:

spring:

summer:

7. What day(s) of the week and time(s) of the day would be best for you to

attend a CONTINUING EDUCATION/TRAINING workshop? (indicate all that

applies and rank 1-4, with best=1)

weekends:

weekdays (indicate which days, if any):

evenings:

daytime:  

day(s) or evening(s) never able to attend:

8. Would you prefer to take workshops (rank 1-3, with best=1)

In person:

Online:    

Blended learning: Online and in person:

9. Alternative venue choice (rank 1-4, with best=1)

Cruise:    

Las Vegas:

Golf:      

Other (indicate which ones):

Optional:

10. Would your firm, organization, or professional group be interested in CEU/Training workshops specifically tailored to meet their needs?:

11. Who can we talk to about providing you with this valuable service?

Contact Person and Title:

Phone #/E-mail:

12. Please, fill out the following so that a member of the MTN team can contact you with the next few days.

Name:    

E-mail:  

Phone #:

Also, please give the best times to reach you:

My Therapy Net, Inc. appreciates you taking the time to fill out this Needs Assessment. We value your responses and look forward to providing you with high quality and informative workshop that will fulfill your CEU/Training needs. If we can be of further assistance to you or your organization/firm please contact us at anytime.

My Therapy Net, Inc.

20501 Ventura Boulevard, Suite 252

Woodland Hills, CA 91364

Phone: (818) 401-0301

Fax: (818) 961-0210

Email: info@mytherapynet.com

Coupon to not be used with any other discount!