Demographic Information
Full Name:
Last 4 digits of SSN:
Address
City
State
Zip
Telephone
Email
Evaluation:
1. As a result of the information contained in this activity, will you make any changes in your practice?
Yes
No
If yes, what changes?
2. In your opinion, how could this activity be improved? (e.g., change format, more details, fewer details, discuss other topics, change length)
3. Please rate the educational value/clinical relevance of this activity.
Excellent/outstanding
Very good
Good/above average
Fair/acceptable
Poor/unacceptable
4. Please rate the extent to which the learning objectives were met.
Excellent/outstanding
Very good
Good/above average
Fair/acceptable
Poor/unacceptable
5. Was the material presented objectively and did it avoid commercial bias?
Yes
No
Comments:
6. Suggestions for future topics:
7. Other comments
