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

Profession

What activities did you attend at the event?

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Agreement

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

I agree

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:

Please rate the speaker(s) as a group. You will have the opportunity to elaborate on an individual speaker in the following question.

Objective 1: Enter overall meeting/conference objective.

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.

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:

Objective 2: Enter overall meeting/conference objective.

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: Enter overall meeting/conference objective.

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.

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Objective 4: Enter overall meeting/conference objective.

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 educational content free of commercial bias?

Was the mode of education effective to learning?

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

If you answered "No" to any of the above questions, please explain.

Were you solicited by sales personnel in an educational room while you attended this educational activity?

If you answered "Yes" to the above question, please explain.

How much did you learn as a result of this educational program?

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?

What patient problems or patient challenges do you feel you are not able to address appropriately or to your satisfaction?

What problems are your patients communicating to you that need attention or follow up?

Are you interested in basic, intermediate or advanced level trainings?

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

How can this training be improved to better impact competence, performance and/or patient 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.