Course Evaluation Form

Information About Yourself

This information is used to maintain records and issue credit to you. Your responses are kept confidential. Please enter the name and personal information that you want used in your certificate.

Name*

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Survey Questions

As an integral part of your educational experience, please reflect upon the knowledge you have learned in this educational activity and demonstrate how you would apply that knowledge to practice in the following clinical vignette and questions below.

Based on what you learned in this educational activity, please tell us one or two specific changes in your practice you are committed to making:*

Was the content of this activity fair, balanced, and free of commercial bias?*

Yes
No

Please explain:

For our continuous improvement processes, please provide any feedback you can share on the following: (write in answers)

Access to the activity:

Quality of faculty/teaching effectiveness:

Future topics we need to address:

Other:

Name

This field is for validation purposes and should be left unchanged.

Information About Yourself

Survey Questions

For our continuous improvement processes, please provide any feedback you can share on the following: (write in answers)

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