Wisconsin Society of Medical Assistants

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Wisconsin Society of Medical Assistants
Need Assessment Survey

Please answer the questions asked below to the best of your knowledge.  The information will be reviewed by the WSMA Executive Committee to help meet the needs of our members.

Which of the following describes your present position? (answer as many that apply to you)

• Are you a AAMA member? __________ ( FYI: membership to AAMA includes your membership to WSMA & your local chapter, it is a tri-level membership)

• Are you a Certified Medical Assistant®? ___________What year did you certify/recertify? ______________

• Are you a non-member? ___________

• Are you a practicing medical assistant? ____________
  if so, what area do you work in? ____________________________________________________________

• Are you a retired medical assistant? _________________________________________________________

• Are you an Medical Assisting Educator? _____________________ At what school? ____________________
  ________________________________________________________________________________________

• If you are not a member, would you be interested in becoming a member of AAMA/WSMA? _____________
  Would you like someone to contact you regarding membership? ___________________________________
  If yes, where can you be reached & what time is best to contact you? ______________________________

• What is your choice for a start time for education sessions? ____________________

• What is your choice for a end time for education sessions? _____________________

• How many ceu's would you like offered at education seminars? __________________
  (one ceu is one hour in length)

• List topics you would like to hear? _____________________________________________________________
  _________________________________________________________________________________________

• Would you like to recommend a speaker that would be interested in speaking at a WSMA education function? (please provide name, location & how can they be contacted)____________________________________ _________________________________________________________________________________________

• How many AAMA/WSMA education sessions do you attend in a year? ________________________________

• Would you like to attend more in a year? _______________________________________________________

• What is the reason you do not attend more? ____________________________________________________

• Would you be interested in joining a WSMA committee? ___________________________________________

• Would you like someone to contact you regarding committees? _______________ If yes, where & when are you able to be reached? _____________________________________________________________________

• Is there anything you feel that the Wisconsin Society of Medical Assistants should be doing for you? _________________________________________________________________________________________
  _________________________________________________________________________________________

Please print this form and send it to: Kim Gropp, CMA, W 703 State Road 21, Berlin WI  54923

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last update:  02/19/2007