Physician's Self-Study Packet

Request Form

Please complete this form. Required fields are marked with an '*'. There is a $100 fee for this packet, which includes all copyrighted materials, a tear-resistant pocket guide, test and evaluation materials, processing the completed test, and issuance of a CME/COE certificate. Your packet will be mailed as soon as payment is received.

Name:*
Discipline:* (this packet is intended for those who are eligible for CME/COE continuing education credits)
Address:*
Email:
Phone:
How did you here about this program?
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Please select your payment method:* (Packet will be sent upon receipt of payment)
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Maine Hospice Council and Center for End of Life Care

Physician's Self-Study Packet

Request Form