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 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 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
