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Monthly Support Group Report 

Complete And Submit Within 7 Days Of Your Meeting

Support Group Location
 * required
Support Group Leader
 * required
Meeting Date  (xx/xx/xxxx)
 * required


Post Surgical
 * required
Pre Surgical
 * required
Considering Surgery
 * required
 * required

Member Email Addresses

Add new member's email addresses so they can receive reminder emails prior to each meeting. 

Member Email
Member Email
Member Email
Member Email
Member Email

Meeting Topic

On Track With Barix Used
Topic Relevance
Highly Relevant
Some Relevance
Poor Relevance

SG Leader Guide Used 

Helpfulness of SGL Guide
Not Helpful
Other Topic/Presenter Utilized
Suggestions for On Track
With Barix Topics

Other Information

Medical / Company Questions Requiring Follow-up
Changes to Meeting Day, Time, Location, Etc



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