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

Profession

What activities did you attend at the event?

Febuary 6th, 2016 9:30 - 1:00

Agreement

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

I agree

Objective: Learners will integrate theoretical and experiential learning

Did you attend the session in its entirety?

Objective: Learners will better understand transference and countertransference in a group setting

Objective: Learners will experience what it's like to be a group member

Please rate the following:

Content matched stated objectives.

Usefulness of handouts/AV.

Quality of facilities.

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 tell us about any objective you feel we accomplished well or poorly.

Please tell us anything about the presenter you found particularly good or bad

Please answer the following:

If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?

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):

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 that you hoped to address by taking this couse?

What patient/client problems or patient/client challenges do you feel would require additional training?

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

How can this training (all modules together) be improved to better impact compenence, performance and/or patient/client outcomes?

Additional comments: