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

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.

What is the number that appears on your license to practice/license number?

What state issued that license?

If you would like your CME reported for additional licenses in additional states, please enter that information sequentially below:

Date of Birth - Month: Please select the number that represents the Month in which you were born (example: March is 03):

Date of Birth - Day: Please enter the day of the month on which you were born (example: if you were born on the 6th, please select 06).