CME Reporting Form

By filling out this form, you are attesting that you have paid for and watched the videos you state here from NevadaOsteopathic.Org/CME

Verified attestations will receive a certificate via email.

Ensure that your e-mail address matches the e-mail used to purchase CME credits.

First Name *

Last Name *

Title *

Email *

Phone

Optional: I wish to receive updates via phone call and/or texting. This will include future opportunities to earn CME.

Board Certified/Eligible In *

AOA Number

To receive credit, select ALL of the Video IDs you viewed.

To find Video IDs, please visit NevadaOsteopathic.org/ID

Please fill out this form ONLY once.

You may select multiple videos in the drop down.

Your Viewed Video IDs *

Printed Name *

By signing electronically below, I certify that the above attestation is true and accurate. *

Clear

“Nevada Osteopathic Medical Association is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. The Nevada Osteopathic Medical Association designates this online program for AOA Category 1-B credits and will report CME and specialty credits with the extent of the physician’s participation in this activity.”

Nevada Osteopathic Medical Association

2245 Springdale Court Reno, NV 89523

855-888-NOMA Fax: 775-384-2865

[email protected]