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

Profession

How many credit hours did you complete?

Credit Hours (maximum: 1.0)

Agreement

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

I agree

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. CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours.

Notice to OhioLicensees: In order for us to report your hours to CE Broker, you MUST provide us with your Ohio alpha-numeric license number (e.g. CDCA.XXXXXX, LICDCII.XXXXXX, LCDCII.XXXXXX, LICDC.XXXXXX). Please be sure to enter this number accurately, or CE Broker will not record your hours.Â

CHES MEMBERS ONLY -- Please enter your CHES ID#

Please rate your satisfaction with the content and quality of the program:

Was the educational content scientifically sound?

Yes

No

If no, please explain...

Did you perceive any commercial bias or influence in the educational content?

Yes

No

If yes, what...

Did this program improve your competence or performance?

Yes

No

If yes, how...

If no, please explain...

What did you learn that will help you in your practice?

The program was up-to-date and relevant to my professional practiceÂ

Were the following objectives met?

Identify sexual dysfunction disorders as defined in the DSMV in the oncology settings and discuss the scope of the issue and barriers to improving assessment and intervention.

Were the following objectives met?

Discuss assessment tools for the screening and identification of such disorders using the NCCN (National Comprehensive Cancer Network) guidelines along with other validated screening tools such as the FSFI (Female Sexual Functioning Index)

Were the following objectives met?

Review the literature to identify empirically based interventions and other methods that have been utilized to address sexual dysfunction in this population.

Was the location suitable?

Yes

No

The facilities were conducive to learning

Yes

No

Not sure

What questions are you having in your practice that you would like to see addressed in an educational activity?

Were questions, concerns and accommodations were addressed efficiently and in a timely manner?

Additional comments, questions or concerns