1. Did you attend this course last year or in the past? * Yes No If yes, how did attending this course change your practice? 2. Of the topics covered in this course, rank the topics in order of importance to you. 1 is least important, 5 is most important 12345 Topic1 Topic1 - 1 Topic1 - 2 Topic1 - 3 Topic1 - 4 Topic1 - 5 Topic2 Topic2 - 1 Topic2 - 2 Topic2 - 3 Topic2 - 4 Topic2 - 5 Topic3 Topic3 - 1 Topic3 - 2 Topic3 - 3 Topic3 - 4 Topic3 - 5 Topic4 Topic4 - 1 Topic4 - 2 Topic4 - 3 Topic4 - 4 Topic4 - 5 Topic5 Topic5 - 1 Topic5 - 2 Topic5 - 3 Topic5 - 4 Topic5 - 5 3. What is a question you would like answered and/or a topic you would like covered in depth during this course? 4. How many patients in a year do you see who would benefit from the content in this activity? 1 to 5 6 to 10 11 to 15 16 to 20 More than 20 N/A 5. What are your reasons for attending this course now? Least ImportantSomewhat ImportantOf Average ImportanceImportantMost Important Assist in my current work Assist in my current work - Least Important Assist in my current work - Somewhat Important Assist in my current work - Of Average Importance Assist in my current work - Important Assist in my current work - Most Important Part of my professional development plan Part of my professional development plan - Least Important Part of my professional development plan - Somewhat Important Part of my professional development plan - Of Average Importance Part of my professional development plan - Important Part of my professional development plan - Most Important To earn credit To earn credit - Least Important To earn credit - Somewhat Important To earn credit - Of Average Importance To earn credit - Important To earn credit - Most Important Cost Cost - Least Important Cost - Somewhat Important Cost - Of Average Importance Cost - Important Cost - Most Important Location Location - Least Important Location - Somewhat Important Location - Of Average Importance Location - Important Location - Most Important Other Other - Least Important Other - Somewhat Important Other - Of Average Importance Other - Important Other - Most Important 6. How did you hear about the course? Email Word of mouth Handout Other... 6. How did you hear about the course? Other... Leave this field blank
