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

Profession

What activities did you attend at the event?

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (1)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (2)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (3)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (4)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (5)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (6)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (7)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (8)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (9)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (10)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (11)

President's Session - No SAM credit - CME only

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (12)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (13)

If you claimed SAM credit for this session(s), skip to next session. If you need CME only credit for this session, select course below. (14)

Agreement

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

I agree

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:

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):

Objective 1: Name three essential elements of acute DVT care that promote favorable long-term outcomes

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

Objective 2: Describe the pathophysiology of mixed arterial and deep venous insufficiency of the lower extremity and the approach to treatment

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

Objective 3: Name three major multidisciplinary initiatives that are underway to assess important DVT treatment outcomes and to improve the quality of care delivered

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

Objective 4: List strategies for improved patient compliance and improved patient selection for different methods of compression

By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.

By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.

By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.

Please answer the following:

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

Was the educational content scientifically sound?

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 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:

Only Florida licensees need to answer this question. Notice to Florida Licensees: In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numeric license number (e.g., PY1234, SS123, MH1234, MT1234). Please be sure you enter this number accurately, or CE Broker will not record your hours.