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

Profession

Agreement

By completing this form, you attest that you have attended the activity in its entirety.

I agree

Please rate the following:

Please rate the speaker(s) as a group. You will have the opportunity to elaborate on an individual speaker in the following question.

If you have additional comments regarding the session or individual speaker(s) - e.g. teaching ability, expertise, organization of materials, etc. - please use the space below:

The program was relevant to my work.

Content matched stated objectives.

Usefulness of handouts/AV.

Quality of facilities.

If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree' please explain:

Please answer the following:

Do you believe this activity was appropriate for the scope of your professional activities?

Was the educational content scientifically sound?

Was the mode of education effective to learning?

If you answered "No" to any of the above questions, please explain.

How much did you learn as a result of this educational program?

Having completed the activity, please rate how well are you able to meet each of the following objectives

Review the history and future of the field of behavioral sleep medicine

Explain sleep diagnostic tests and commonly utilized behavioral sleep evaluation procedures

Apply a cognitive behavioral approach to treating chronic insomnia and other sleep disorders

Adapt cognitive behavioral treatment approaches to those experiencing co-existing anxiety, depression and other conditions

Discuss basic circadian science and apply this knowledge to managing circadian rhythm sleep disorders

Develop approaches to assisting patients dependent on sleep agents

Apply cognitive behavioral approaches to managing common pediatric sleep disturbances

Develop strategies to managing nightmares and other parasomnias

Discuss basic behavioral sleep billing procedures

Discuss the role of behavioral sleep specialists in the management of sleep apnea

What did you learn during this activity that you intend to integrate into your practice?

What do you "need" to learn (versus "want" to learn) that should be addressed in future meetings that will result in improved competence, performance and/or patient outcomes in your practice?

Are you interested in basic, intermediate or advanced level trainings?

Basic

Intermediate

Advanced

What barriers might you have that would interfere with implementation of new information from this training?

How could this training (the overall meeting) be improved to impact your competence or performance in practice?

Additional comments: