Course Forms, Evaluation & Certificate
Name As You Want On Your Certificate (Please fill all the boxes)
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First Name
Last Name
Credentials
Email
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Cell Phone Number
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Date (Please put the date of the Webinar)
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-
Month
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Day
Year
Date
LICENSE NUMBER (S) & STATE(S) - (please fill in with your credentials)
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POST COURSE KNOWLEDGE TEST
Please click the correct answer - True/False
The effects of dry needling are increasingly being viewed as neurologically driven.
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True
False
The basis of TMR is using movement to enhance neurological control.
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True
False
TMR concepts can be used to both identify areas to perform dry needling and lock in improvements made with dry needling.
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True
False
When performing TMR, you should focus your attention on Yucky motions.
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True
False
When the seated twist is yucky, you can either twist towards the Yummy direction, dry needle thethoracic multifidus, or both.
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True
False
Exercise is the only way the body can lock in permanent, long-lasting changes in the nervous system.
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True
False
When performing TMR, always start with training the arm raise, regardless of the injury or issue.
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True
False
Dry needling is an effective way of down regulating tone and improving mobility in an area, oftentimes setting the stage for improved movement patterns.
True
False
When rating a movement in the TMR system, the scale of 0-100 only refers to the patient’s pain level.
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True
False
Both dry needling and TMR appear to have a global impact on the nervous system, allowing changes to be made in areas that are seemingly unrelated to the complaint area.
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True
False
EVALUATION FORM
Name Of The Instructor :
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Mitch Hauschildt
YOUR OVERALL SATISFACTION WITH THE COURSE (1 POOR, 5 EXCELLENT)?
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5
4
3
2
1
CONFIDENCE IN RECOMMENDING THIS COURSE TO OTHERS (1 POOR, 5 EXCELLENT)?
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5
4
3
2
1
THE INFORMATION RECEIVED WAS USEFUL AND BENEFICIAL
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM MET THE STATED LEARNING OBJECTIVES
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PRESENTATION STYLE ENHANCED MY LEARNING EXPERIENCE
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM FACULTY WAS RESPONSIVE TO QUESTIONS/COMMENTS
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE EDUCATIONAL MATERIALS WERE USEFUL?
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE LEARNING ASSESSMENT (TEST) WAS APPROPRIATE
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
WHAT DID YO LIKE MOST ABOUT THIS PROGRAM?
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WHAT DID YO LIKE LEAST ABOUT THIS PROGRAM?
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DO YOU FEEL THERE WAS COMMERCIAL BIASE OR INFLUENCE IN THIS ACTIVITY?
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YES
NO
IF YES, PLEASE EXPLAIN
PLEASE RATE THE FOLLOWING COMPONENTS OF THIS PROGRAM
REGISTRATION PROCESS
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EXCELLENT
GOOD
FAIR
POOR
PROGRAM FACULTY
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EXCELLENT
GOOD
FAIR
POOR
WAS THE PROGRAM FACULTY KNOWLEDGEABLE REGARDING THE CONTENT OF THEIR PRESENTATION
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YES
NO
WAS THE PROGRAM FACULTY RELEVANT REGARDING THE CONTENT OF THEIR PRESENTATION
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YES
NO
WAS THE PROGRAM FACULTY EFFECTIVE WITH THE CONTENT OF THEIR PRESENTATION
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YES
NO
IF YOU ANSWERED NO TO ANY OF THE 3 QUESTIONS ABOVE PLEASE EXPLAIN
THE PRESENTATION MET MY EXPECTATIONS
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM FACULTY STYLE WAS APPROPRIATE FOR THE MATERIAL PRESENTED
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM FACULTY WAS RESPONSIVE TO QUESTIONS/COMMENTS
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE PROGRAM MET MY OBJECTIVES
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STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
THE INFORMATION RECEIVED WAS USEFUL AND BENEFICIAL
*
STRONGLY AGREE
AGREE
DISAGREE
STRONGLY DISAGREE
GENERAL COMMENTS
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