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2024 FPRR Attestation Form

Participants in the program are requested to complete the evaluation form following the entire program. 

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Question 1 of 5

Affiliation

A

Practicing Physician

B

Retired Physician

C

Resident

D

Medical Student

E

Nurse or Nurse Practitioner

F

PA

Question 2 of 5

Are you an active member of AAFP? If so, do you participate to obtain AAFP prescribed credits? 

Question 3 of 5

I hereby certify that I watched the "Virtual" 29th Annual Family Practice Review and Reunion.  The Family Practice Review and Reunion program is designed to comply with the Uniform Guidelines for Accredited Agencies of Continuing Medical Education.  Attendees should only claim those hours of credit actually spent in the educational activity.  AOA CME credits will not be reported to the AOA until a completed attestation statement is completed. Please indicate number of credit hours below. 24 is the max for AOA credits. Please assign a number only.

Question 4 of 5

Are you Board Certified by the American Osteopathic Board of Family Practitioners?

A

Yes

B

No

Question 5 of 5

Please Write FULL Name, Date & AOA Number (If applicable)

Confirm and Submit