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 in detail (e.g. session title, speaker name, situation):

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

Describe the latest treatment options for multiple addictions

Explain the definitions, causes and symptoms of eating disorders, chemical dependence, and self-injurious behavior

Summarize the current research on dual & multiple addictions

Identify the interrelationships between dual diagnoses

Practice practical treatment approaches for therapists in MI/CD cases and in their work with difficult, complicated cases

What specifically 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/client 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, performance and/or patient/client outcomes?

Additional comments:

Only Florida licensees need to answer this question. Notice to Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numeric license number (e.g., PY1234, SS123, MH1234, MT1234). Please be sure you enter this number accurately, or CE Broker will not record your hours.