GEST MSK 2025 - Request for a grant support local

Family name*

First name*

E-mail adress*

Cell phone number*

Cell phone number (only) Please indicate in front of your phone number, the country dialling code of your country.

Affiliated Medical Center*

Country*

City*

REGISTRATION

I register as :*

Physician
Fellow
Intern
Paramedics

N° RPPS (only for french physician/paramedic)*

If you do not have an RPPS number, please note in this section "N/A".

Did you attend the GEST MSK 2024 meeting in Paris?*

Yes
Non

Do you currently perform MSK embolization?*

Yes
Non

Please indicate what procedures and how many you have done until now : GEA*

Less than 5 cases
5-9 cases
More than 10 cases

Frozen Shoulder*

Less than 5 cases
5-9 cases
More than 10 cases

Epicondylitis*

Less than 5 cases
5-9 cases
More than 10 cases

Other (please specify procedure name and number of cases)

Based on what you know, which of the following companies have products or will be introducing products for embolotherapy in MSK in the next year?*

Guerbet
Merit Medical
Terumo
Boston Scientific
Cook Medical
Varian
Other (please specify)

Other (please specify)*

What embolic material(s) have you been using?*

Embosphere
Embozene
Lipiodol emulsion
Imipenem-cilastatin
Other

Other (please specify)*

What embolic material(s) would you like to use in the coming year?*

Embosphere
Embozene
Lipiodol emulsion
Imipenem-cilastatin
Other

Other (please specify)*

What is your preferred microcatheter?*

What is the main limitation for you to start/grow your practice?*

Not confident enough
Not enough evidence
No referral by rheumatologist/orthopedic
No access to an embolic in which I am confident
Not convinced that this will work

In what ways can we help you in overcoming the limitation you mentioned?*

How knowledgeable would you say you are about performing MSK procedures?*

I'm a newbie
More to learn
I'm an expert

How would you like to learn more about MSK procedures? Check all that apply.*

An MSK Online Community
In-depth, interactive webinars on MSK
MSK focused In-person meeting
Visit an expert center and attend cases
A certificate program to build your practice

Do you have access to Imipenem Cilastatin?*

Yes
No

How long have you been a practicing physician?*

In what country do you practice?*

What is your area of specialty*

Interventional Radiology

What is your practice setting?*

Academic
Private Practice
VA/Government
For profit hospital/health system
Not for profit hospital/health system

Email

Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

GEST MSK 2025 – Request for a grant support local

GEST MSK 2025 - Request for a grant support

REGISTRATION

CONTACT

Mrs Sacha Meynard for GEST MSK Registration