TMR LEVEL 1 - Certificate & Forms

TMR LEVEL 1 - Course Form Submission & Certificate
IT IS BEST TO USE CHROME BROWSER WHEN FILLING OUT THIS FORM
Name As You Want On Your Certificate*

First NameLast NameCredentials
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Date ( If taking Live/Live-online please put the last date of the seminar. If taking it as Homestudy please put today's date)*

MonthDayYear
Date
SEMINAR TYPE: LIVE (if taken online Sat/Sun for all but MTs), LIVE ONLINE (if taken Sat/Sun for MTs), ONLINE (if not taken on Sat/Sun - Homestudy)*
LICENSE NUMBER (S) & STATE(S) - optional
How would you rate this Seminar (1 star - sucks, 5 stars - Awesome)*
Is it ok to use a few of your before and after videos for our marketing to share with other clinicians and general public

YESNO
Evaluation Questions :
Please rank on a scale of 1 to 5 to the following questions: (1=Poor 5=Excellent)
1. Your overall satisfaction with the course?*

12345
2. Current level of confidence you now have of TMR ?*

12345
3. Ability you have to begin using it on patients Monday ?*

12345
4. Confidence in recommending this course to others ?*

12345
5. Please rate the following components of this program:
a. The information received was useful and beneficial.*

Strongly AgreeAgreeDisagreeStrongly Disagree
b. The program met the stated learning objectives.*

Strongly AgreeAgreeDisagreeStrongly Disagree
c. The presentation style enhanced my learning experience.*

Strongly AgreeAgreeDisagreeStrongly Disagree
d. The educational materials were useful.*

Strongly AgreeAgreeDisagreeStrongly Disagree
e. The learning assessment (survey, quiz, etc.) was appropriate.*

Strongly AgreeAgreeDisagreeStrongly Disagree
6. What did you like the most about this program?*
7. What did you not like about the seminar, if anything? I use your critique to make classes even better. So if you have something that I can do better let me know.*
8. Did you feel that there was commercial bias or influence in this activity?*

YesNo
If Yes, please explain -
9. Identify topics you would like to have presented at future meetings.*
10. Please rate the following components of this program:
a. Registration process -*

ExcellentGoodFairPoor
b. Program faculty*

ExcellentGoodFairPoor
11. Were the following program faculty knowledgeable regarding the content of their presentation? - Tom Dalonzo-Baker*

YesNo
12. Were the following program faculty relevant regarding the content of their presentation? - Tom Dalonzo-Baker*

YesNo
13. Were the following program faculty effective regarding the content of their presentation? - Tom Dalonzo-Baker*

YesNo
If you answered no to any of the above 3 questions (Q.11, Q.12, Q.13), please explain:
14. Please rate the following components of this program:
a. The presentation met my expectations.*

Strongly AgreeAgreeDisagreeStrongly Disagree
b. The program faculty style was appropriate for the material presented.*

Strongly AgreeAgreeDisagreeStrongly Disagree
c. The program faculty was responsive to questions/comments.*

Strongly AgreeAgreeDisagreeStrongly Disagree
d. The program met my objectives.*

Strongly AgreeAgreeDisagreeStrongly Disagree
e. The information received was useful and beneficial.*

Strongly AgreeAgreeDisagreeStrongly Disagree
Type a question
Testimonial :
If you did a video testimonial on Marco Polo app just write in this box SEE MARCO POLO. The goal of writing your testimonial is to inform other therapists your thoughts about the course and your experience with it. What happened to you physically during the course and how did it change your thinking? If you took the seminar online – how did you like that experience? Thanks for taking the time to share.
UPLOAD ALL FORMS FROM EVERY LESSON HERE
UPLOAD HERE: TAKE PICS OF FORMS ON CAMERA. HIT BROWZE FILES AND THEN GO TO PHOTO GALLERY AND SELECT PICS OF FORMS.*

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TMR LEVEL 1 - Course Form Submission & Certificate

IT IS BEST TO USE CHROME BROWSER WHEN FILLING OUT THIS FORM

Evaluation Questions :

Please rank on a scale of 1 to 5 to the following questions: (1=Poor 5=Excellent)

5. Please rate the following components of this program:

10. Please rate the following components of this program:

14. Please rate the following components of this program:

Testimonial :