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Request Clinical Training Form – Nexplanon Training
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Clinical Training

Program (CTP)

for NEXPLANON
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Request Clinical Training

Training Request Form

The Clinical Training Program for NEXPLANON is offered to all eligible healthcare professionals. Complete the request form below to learn about upcoming training programs.

This session, which is sponsored by Organon, is not accredited for continuing education credit. The training is open only to MD/DO, NP, PA or CNMs, and Residents authorized to perform the procedures entailed in the insertion and removal of NEXPLANON in the jurisdiction where they practice. Additionally, NPs, PAs, and CNMs must attest that they have met all specific state conditions and requirements, including but not limited to signing a collaborative agreement with an MD/DO. Residents must understand that they can only administer NEXPLANON under the supervision of an attending healthcare professional who has also been trained on the procedures to insert and remove NEXPLANON. It is Organon's policy to verify all clinicians' practice, US license, and eligibility information in advance of the training. Organon will contact you directly if there is a problem. Attendees are expected to attend the entire training. Certificates of attendance will not be issued to those who arrive late or leave early.

We understand and respect that your privacy is important to you. The personal and practice information that you provide will be used only for communication relevant to the Clinical Training Program. For more details and for concerns about the confidentiality of your personal information, please refer to our Privacy Policy.

* = Required

To finish registering, please complete fields with missing or incorrect information.

 
 
Personal Information
*First name
Middle initial
*Last name
Suffix (eg, Jr., Sr., III)
Professional Information
*Professional designation
*Please specify
*Specialty
*Please specify
National Provider Identifier Number (NPI)
*Are you a resident?
Practice Information
*Primary practice type
*Please specify
*Primary practice name
*Street address 1
Street address 2
*City
*State
*ZIP code
*Distance willing to travel for training
Your phone number and e-mail address are being requested in order for us to communicate directly with you only in relation to the Clinical Training Program, unless you have chosen otherwise. Please see our Privacy Policy for additional information.
*Phone number
*Confirm e-mail address