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

Profession

What activities did you attend at the event?

Monday, November 11 - 8:00 AM - 12:00 PM - Session I

Tuesday, November 12 - 8:00 AM - 12:00 PM - Session II

Tuesday, November 12 - 1:30 PM - 5:30 PM - Session III

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.

Quality of facilities.

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):

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:

Having completed the activity, please rate your ability to meet each of the following objectives:

Identify the psychological and behavioral issues commonly present in candidates for bariatric surgery

Describe the cognitive, emotional and behavioral changes that patients experience following a surgical weight loss procedure

Evaluate the role of the mental health professional on the bariatric surgical team

Explain some of the professional and ethical issues that arise in the treatment of the bariatric surgery patient

Identify the psychological and behavioral issues commonly present in candidates for bariatric surgery

Describe the cognitive, emotional and behavioral changes that patients experience following a surgical weight loss procedure

Evaluate the role of the mental health professional on the bariatric surgical team

Identify the psychological and behavioral issues commonly present in candidates for bariatric surgery

Describe the cognitive, emotional and behavioral changes that patients experience following a surgical weight loss procedure

Evaluate the role of the mental health professional on the bariatric surgical team

Explain some of the professional and ethical issues that arise in the treatment of the bariatric surgery patient

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.

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 have arisen in your practice for which you need answers/strategies that you can implement?

What patient/client problems or patient/client challenges do you feel you are not able to address appropriately or to your satisfaction?

What problems are your patients/clients communicating to you that need attention or follow up?

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?

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

Additional comments: