Expression of InterestCultivating Physician Well-Being: An Organizational Roadmap for Leaders

First and Last Name*

Email Address*

Name of Organization*

What is your role in your organization?*

Please estimate the number of participants from your organization who would be interested in attending a course.*

If you are unsure, please enter '3', as this is the minimum number of participants required for participation in this course.

Please choose all that apply to you / your organization with respect to your current journey toward physician well-being in your workplace.*

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