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

Profession

What activities did you attend at the event?

Wednesday - 8:00 am - 9:00 am

Wednesday - 9:00 am - 10:00 am

Wednesday - 10:00 am - 11:00 am

Wednesday - 11:00 am - 12:00 pm

Wednesday - 12:00 pm

Wednesday - 1:00 pm - 2:00 pm

Wednesday - 2:00 pm - 3:00 pm

Wednesday - 3:00 pm - 4:00 pm

Wednesday - 4:00 pm - 5:00 pm

Wednesday - 5:00 pm - 5:30 pm

Wednesday - 5:30 pm - 6:00 pm

Thursday - 8:00 am - 8:45 am

Thursday - 8:45 am - 9:30 am

Thursday - 9:30 am - 10:15 am

Thursday - 10:15 am - 10:30 am

Thursday - 10:30 am - 11:30 am

Thursday - 11:30 am - 12:30 pm

Thursday - 12:30 pm - 1:00 pm

Thursday - 1:30 pm - 2:30 pm

Thursday - 2:30 pm - 3:30 pm

Thursday - 3:30 pm - 4:30 pm

Thursday - 4:30 pm - 5:00 pm

Thursday - 5:00 pm - 5:45 pm

Thursday - 5:45 pm - 6:00 pm

Friday - 8:00 am - 8:45 am

Friday - 8:45 am - 9:30 am

Friday - 9:30 am - 10:15 am

Friday - 10:15 am - 11:00 am

Friday - 11:00 am - 11:45 am

Friday - 11:45 am - 12:00 pm

Friday - 12:30 pm - 1:15 pm

Friday - 1:15 pm - 2:00 pm

Friday - 2:00 pm - 2:45 pm

Friday - 2:45 pm - 3:30 pm

Friday - 3:30 pm - 4:15 pm

Friday - 4:15 pm - 5:00 pm

Friday - 5:00 pm - 5:45 pm

Friday - 5:45 pm - 6:00 pm

Agreement

By completing this form, you attest that you have participated in all selected activities in thier entirety.

I agree

Please rate the following:

The program was relevant to my work.

Content matched stated objectives.

Usefulness of handouts/AV/technology.

Quality of facilities and facility accommodations.

How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?

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, situtation):

The instructor was knowledgeable about the content

The instructor presented the subject matter clearly

The instructor was responsive to participants

Did this program improve your Skill or Strategy in your role or contribution as a member of the healthcare team?

Yes

No

If no, why not?

Do you believe your participation in this activity will positively impact your healthcare team?

Yes

No

If yes, how?

If no, why not?

The instructor used technology effectively

Please tell us about any objectives you feel we accomplished well or poorly.

Please answer the following:

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

Was the educational content scientifically sound?

If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?

Was the mode of education effective to learning?

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

Did you perceive any product/service/company/commercial bias in any educational session you attended or materials you received?

If you answered "Yes" to the above question, please detail the situation below (e.g. session title, speaker name):

Were you solicited by sales personnel in an educational room (other areas do not matter) while you attended this educational activity?

If you answered "Yes" to the above question, please explain in detail (e.g. who, when, where):

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

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

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

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 learned from this training?

Additional comments: