JT IN PERSON Draft Registration

Will you attend virtually or in-person? *

In-person

Virtually

Do you have any dietary restrictions? *

Yes

No

If yes, please provide information about your dietary restriction:

Do you have any accommodation or accessibility requests? *

Yes

No

In-person Attestation *

By selecting yes, I am requesting (1) CE credit for (node for discipline) and attest that I have been present for this entire session.

Yes

No

Please fill in your rating: *

	Strongly Agree	Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree	Not Applicable
Faculty was knowledgeable, effective and clear in the delivery of content:	Faculty was knowledgeable, effective and clear in the delivery of content: - Strongly Agree	Faculty was knowledgeable, effective and clear in the delivery of content: - Agree	Faculty was knowledgeable, effective and clear in the delivery of content: - Somewhat Agree	Faculty was knowledgeable, effective and clear in the delivery of content: - Somewhat Disagree	Faculty was knowledgeable, effective and clear in the delivery of content: - Strongly Disagree	Faculty was knowledgeable, effective and clear in the delivery of content: - Not Applicable
Facutly and moderator were responsive to audience input	Facutly and moderator were responsive to audience input - Strongly Agree	Facutly and moderator were responsive to audience input - Agree	Facutly and moderator were responsive to audience input - Somewhat Agree	Facutly and moderator were responsive to audience input - Somewhat Disagree	Facutly and moderator were responsive to audience input - Strongly Disagree	Facutly and moderator were responsive to audience input - Not Applicable
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 #1 was met: - Not Applicable
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 #2 was met: - Not Applicable
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	Learning Objective #3 was met: - Not Applicable
Presentation was relevant to your needs or interests	Presentation was relevant to your needs or interests - Strongly Agree	Presentation was relevant to your needs or interests - Agree	Presentation was relevant to your needs or interests - Somewhat Agree	Presentation was relevant to your needs or interests - Somewhat Disagree	Presentation was relevant to your needs or interests - Strongly Disagree	Presentation was relevant to your needs or interests - Not Applicable
Content met expectations	Content met expectations - Strongly Agree	Content met expectations - Agree	Content met expectations - Somewhat Agree	Content met expectations - Somewhat Disagree	Content met expectations - Strongly Disagree	Content met expectations - Not Applicable
Content was current	Content was current - Strongly Agree	Content was current - Agree	Content was current - Somewhat Agree	Content was current - Somewhat Disagree	Content was current - Strongly Disagree	Content was current - Not Applicable
Satisfactory and quality education materials	Satisfactory and quality education materials - Strongly Agree	Satisfactory and quality education materials - Agree	Satisfactory and quality education materials - Somewhat Agree	Satisfactory and quality education materials - Somewhat Disagree	Satisfactory and quality education materials - Strongly Disagree	Satisfactory and quality education materials - Not Applicable
Technology was easy to use	Technology was easy to use - Strongly Agree	Technology was easy to use - Agree	Technology was easy to use - Somewhat Agree	Technology was easy to use - Somewhat Disagree	Technology was easy to use - Strongly Disagree	Technology was easy to use - Not Applicable
Course registration process was easy to use	Course registration process was easy to use - Strongly Agree	Course registration process was easy to use - Agree	Course registration process was easy to use - Somewhat Agree	Course registration process was easy to use - Somewhat Disagree	Course registration process was easy to use - Strongly Disagree	Course registration process was easy to use - Not Applicable
Adminitstrative staff were responsive to questions or concerns	Adminitstrative staff were responsive to questions or concerns - Strongly Agree	Adminitstrative staff were responsive to questions or concerns - Agree	Adminitstrative staff were responsive to questions or concerns - Somewhat Agree	Adminitstrative staff were responsive to questions or concerns - Somewhat Disagree	Adminitstrative staff were responsive to questions or concerns - Strongly Disagree	Adminitstrative staff were responsive to questions or concerns - Not Applicable
Content presented in this session will affect your treatment decisions?	Content presented in this session will affect your treatment decisions? - Strongly Agree	Content presented in this session will affect your treatment decisions? - Agree	Content presented in this session will affect your treatment decisions? - Somewhat Agree	Content presented in this session will affect your treatment decisions? - Somewhat Disagree	Content presented in this session will affect your treatment decisions? - Strongly Disagree	Content presented in this session will affect your treatment decisions? - Not Applicable
Accommodations were satisfactory and adequate	Accommodations were satisfactory and adequate - Strongly Agree	Accommodations were satisfactory and adequate - Agree	Accommodations were satisfactory and adequate - Somewhat Agree	Accommodations were satisfactory and adequate - Somewhat Disagree	Accommodations were satisfactory and adequate - Strongly Disagree	Accommodations were satisfactory and adequate - Not Applicable
Accesssibilty accommodations were easy to access	Accesssibilty accommodations were easy to access - Strongly Agree	Accesssibilty accommodations were easy to access - Agree	Accesssibilty accommodations were easy to access - Somewhat Agree	Accesssibilty accommodations were easy to access - Somewhat Disagree	Accesssibilty accommodations were easy to access - Strongly Disagree	Accesssibilty accommodations were easy to access - Not Applicable

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 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:

Amount of time taken to complete this activity: *

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JT IN PERSON Draft Registration