Q1 * Did you attend this course last year? Yes No If yes, how did attending this course change your practice? If yes, how did attending this course change your practice? A Great Deal Much Somewhat Little Never Q2 * Of the topics covered in this course, rank the topics in order of importance to you. 1 Not Important2345 Very Important Topic1 Topic1 - 1 Not Important Topic1 - 2 Topic1 - 3 Topic1 - 4 Topic1 - 5 Very Important Topic2 Topic2 - 1 Not Important Topic2 - 2 Topic2 - 3 Topic2 - 4 Topic2 - 5 Very Important Topic3 Topic3 - 1 Not Important Topic3 - 2 Topic3 - 3 Topic3 - 4 Topic3 - 5 Very Important Topic4 Topic4 - 1 Not Important Topic4 - 2 Topic4 - 3 Topic4 - 4 Topic4 - 5 Very Important Q3 * What is a question you would like answered and/or a topic you would like covered in depth during this course? Q4 * 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 Q5 * What are your reasons for attending this course now? 1 Not Important2345 Very Important Assist in my current work Assist in my current work - 1 Not Important Assist in my current work - 2 Assist in my current work - 3 Assist in my current work - 4 Assist in my current work - 5 Very Important Part of my professional development plan Part of my professional development plan - 1 Not Important Part of my professional development plan - 2 Part of my professional development plan - 3 Part of my professional development plan - 4 Part of my professional development plan - 5 Very Important To earn credit To earn credit - 1 Not Important To earn credit - 2 To earn credit - 3 To earn credit - 4 To earn credit - 5 Very Important Cost Cost - 1 Not Important Cost - 2 Cost - 3 Cost - 4 Cost - 5 Very Important Location Location - 1 Not Important Location - 2 Location - 3 Location - 4 Location - 5 Very Important Other Other - 1 Not Important Other - 2 Other - 3 Other - 4 Other - 5 Very Important Leave this field blank
