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

Profession

How many credit hours did you complete?

Credit Hours (maximum: 0.0)

Agreement

By completing this form, you attest that you have attended the number of hours you have indicated above.

I agree

This activity gave me strategies I could use in my practice or professional activities (professional competence).

I was able to use the strategies from this activity to improve my professional performance.

My patient/client outcomes improved due to the implementation of the strategies I acquired from this activity.

I was able to transfer information from this activity into my practice or professional activities.

An example of information I was able to transfer from this activity is:

I was unable to transfer information from this activity due to the following barriers:

My professional competence (available strategies) would be improved if I had training on:

My professional performance (implementation of strategies) would be improved if I had training on:

My patient/client outcomes (the result of implemented strategies) would be improved if I had training on:

Provide your comments and suggestions to further improve your competence, performance and/or your patient/client outcomes in future activities: