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:

The program was relevant to my work.

Content matched stated objectives.

Usefulness of handouts/AV.

If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree' please explain:

How well were the overall meeting objectives met?

Please answer the following:

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

Was the educational content scientifically sound?

Was the educational content free from commercial bias?

Was the mode of education effective for learning?

If you answered 'No' to any of the above questions, please explain:

If you answered 'Yes' to the above question, please explain:

What 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?

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 be improved to impact your competence or performance in practice?

Additional comments: