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

If you are claiming MOC points, please indicate the program(s) for upload (if you select a program not available for this activity, your points cannot be uploaded):

Please enter your Learner ID# - example: 123456. If you do not know your Board ID, you will need to contact your Board for this information.

Please enter the Month and Day of your Date of Birth (MM/DD) - For example, if your birthday is Septermber 9th, please enter 09/09.

Was the educational content of value to you?

Was the educational content scientifically sound?

If no, Tell us how...

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

If yes, what...

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

If no, why not?

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

If yes, tell us how... Or if no, tell us why not...

Do you think what you learned will benefit you in your practice?

If yes, how...

Tell us how well or poorly we met any of the educational objectives:

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

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

How can this training (the overall meeting) be improved to better impact knowledge, strategies/skills, performance and/or patient outcomes?

Tell us what was good or bad about any part of the educational activity, content, speakers, materials, anything at all.