MPS Request for Certificate, Course Evaluation and Quiz

First Name*

Last Name*

Occupation*

License #*

Please enter all of your license numbers. Enter N/A if this does not apply to you.

CE Broker - Florida*

Please check YES if you are licensed in Florida and require us to submit CE hours.

Email (We only send MPS info)*

Instructor*

MPS COURSE EVALUATION

Course material was clear and easy to understand.*

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.

MPS COURSE OBJECTIVES QUIZ

1. What DOES NOT influence the ANS in LRT*

2. Which is NOT an example of an immune cell?*

3. Why do we release the diaphragm?*

4. What point do we use to release the diaphragm with Du 9?*

5. Where are white blood cells converted to T-cells?*

Overview