Training Scheduling Questionnaire

Please fill out and submit the form below.

 

  • Who is the person we should contact about training details?

    Facility Name*

  • Patient Population*


  • Full Name*
       
  • Full Address*(Street/City/State/Zip)
  • Title*
  • Phone*
  • Email*
  • Fax
  • Contact phone number, day of presentation (Cell Preferred):
  • Cell #*

    • Scheduling preferences:

  • I am interested in:*
    One 4 hr. Session
    Combination online & onsite training
    Group lecture followed by 2 groups for hands on practice
    2 back to back 2 hr. sessions

  • Time Preference for 4 hour session or 3 hour hands on:*


    Day of week (1st choice):    
  • Day of week (2nd choice):   

  • Time of day:* Morning (i.e. 8-12)   Afternoon (i.e. 12-4)   Other
  • If other..Please specify :

  • Time preference for online: (if applicable):


    Day of week (1st choice):    
    Day of week (2nd choice):    

  • Time of day: Morning (i.e. 8-12)   Afternoon (i.e. 12-4)   Other
    If other..Please specify :


* Fields marked with an asterisk are required.

Please contact the Sales, Education or IT Department for further information.

800.332.WALK  •  sales@litegait.com  •  education@litegait.com •  IT@litegait.com

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