Please fill in your rating: *

	Strongly Agree	Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
Faculty was knowledgeable	Faculty was knowledgeable - Strongly Agree	Faculty was knowledgeable - Agree	Faculty was knowledgeable - Somewhat Agree	Faculty was knowledgeable - Somewhat Disagree	Faculty was knowledgeable - Strongly Disagree
Presentation was relevant to your needs	Presentation was relevant to your needs - Strongly Agree	Presentation was relevant to your needs - Agree	Presentation was relevant to your needs - Somewhat Agree	Presentation was relevant to your needs - Somewhat Disagree	Presentation was relevant to your needs - Strongly Disagree
Learning Objective #1 was met	Learning Objective #1 was met - Strongly Agree	Learning Objective #1 was met - Agree	Learning Objective #1 was met - Somewhat Agree	Learning Objective #1 was met - Somewhat Disagree	Learning Objective #1 was met - Strongly Disagree
Learning Objective #2 was met	Learning Objective #2 was met - Strongly Agree	Learning Objective #2 was met - Agree	Learning Objective #2 was met - Somewhat Agree	Learning Objective #2 was met - Somewhat Disagree	Learning Objective #2 was met - Strongly Disagree
Learning Objective #3 was met	Learning Objective #3 was met - Strongly Agree	Learning Objective #3 was met - Agree	Learning Objective #3 was met - Somewhat Agree	Learning Objective #3 was met - Somewhat Disagree	Learning Objective #3 was met - Strongly Disagree
Facility and accommodations were comfortable	Facility and accommodations were comfortable - Strongly Agree	Facility and accommodations were comfortable - Agree	Facility and accommodations were comfortable - Somewhat Agree	Facility and accommodations were comfortable - Somewhat Disagree	Facility and accommodations were comfortable - Strongly Disagree
Satisfactory content and quality education materials	Satisfactory content and quality education materials - Strongly Agree	Satisfactory content and quality education materials - Agree	Satisfactory content and quality education materials - Somewhat Agree	Satisfactory content and quality education materials - Somewhat Disagree	Satisfactory content and quality education materials - Strongly Disagree

How much will the information presented in this session affect your treatment decisions? *

Highly Affect

Somewhat Affect

Slightly Affect

Not at All

This activity will assist in the improvement of my: *

Competence

Performance

Patient Outcomes

Knowledge

Was bias shown toward commercial product or service? *

No

Maybe

Yes

If yes, please explain: *

Will the content learned from this activity impact your practice? *

Yes

No

If yes, please provide two examples of the applicable information:

If no, what are the barriers to application of this information:

What educational information do you need to improve your practice?

What challenges are you facing in your practice?

Comments:

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