EVALUATION & FEEDBACK FORM
Kindly complete the questionnaire and help us to evaluate the usefulness of this program
Name
*
First Name
Last Name
Email
*
example@example.com
Please indicate your affiliation:
*
Staff Physician
Fellow
Resident
Nurse Practitioner
Respiratory Therapist
Allied Health
Sonographer
Other
1. Evaluation for Day 1, Feb 05, 2020
*
Of little or no use to me
Of some use to me
Useful
Very useful with minor shortcomings
Extremely useful
Didactic sessions
Workshop
2. Did you perceive any degree of bias in any part of the program?
*
YES
NO
If YES, please explain
3. Please rate your overall impressions of the whole program
*
YES
NO
Did you find this course interesting?
Did this program meet your expectations?
Was there adequate provision for questions and discussion?
Was the program organized to your satisfaction?
Did you learn something new from this program?
Did you learn something you would use in your practice?
4. As a result of this activity I plan to incorporate the following changes into my practice:
*
5. Please rate the following as it pertains to this whole workshop organization:
*
Not Applicable
Poor
Fair
Average
Somewhat Good
Good
Excellent
Brochure
Registration process
Email communications
Website
ebook
Facility/Nutrition Breaks
Audio Visual
Overall Satisfaction
6. What changes would you suggest to improve the format of the program?
*
7. Additional comments and feedbacks
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