How would you like your name to appear on your certificate?

Profession

How many credit hours did you complete?

Credit Hours (maximum: 7.25)

Agreement

By completing this form, you attest that you have attended the number of hours you have indicated above.

I agree

Was the educational content of value to you?

Very Valuable

Average

Not Valuable

If the educational content was not of value, please explain.

Was the educational content scientifically sound?

Yes

No

If no, please explain.

Did you perceive any commercial bias or influence in the educational content?

Yes

No

If yes, please explain.

Please indicate how your level of knowledge increased, if at all, in attending this activity.

Little/No increase in knowledge

Some increase in knowledge

Considerable increase in knowledge

Do you think what you learned will benefit you in your practice and impact your healthcare team?

Yes

No

If yes, how?

Tell us what part of the educational activity (content, speakers, material, etc.) you found beneficial to you.

What questions are you having in your practice that you would like to see addressed in an educational activity?

Please briefly describe 2-3 strategies you will implement, in your role or contribution as a member of the healthcare team, as a result of having participated in this activity.

Suggestions for future topics/speakers:

Final Comments: