CME Evaluation Survey Please complete and return this form on the date of completion in order to receive CME credit. CME Evaluation Survey Title of Lecture(Required) CME Course Number(Required)Name(Required) First Last Email(Required) Date(Required) MM slash DD slash YYYY Will information gained from this program result in enhancing optimal patient care?(Required)YesNoIf yes, please list change(s) you intend to make in your practice as a result of this program.Please rate your confidence in implementing these changes.(Required)High ConfidenceModerate ConfidenceLow/No ConfidenceN/APlease identify any barriers you perceive in implementing these changes (select all that apply).(Required)CostPatient compliance issuesLack of administrative support/resourcesInsurance/reimbursement issuesLack of consensus of professional guidelinesLack of time to assess/counsel patientsHow will you address these barriers to implement changes in knowledge and behavior?The material was presented at an appropriate level.(Required)PoorFairAverageGoodExcellentI have gained knowledge that will improve patient care.(Required)PoorFairAverageGoodExcellentThe program content was objective, balanced and free from commercial bias or influence.(Required)PoorFairAverageGoodExcellentDid the program meet your expectations in accomplishing the stated educational objectives?(Required)PoorFairAverageGoodExcellentPlease provide your overall rating of the quality of the education offered watching this program.(Required)PoorFairAverageGoodExcellentAdditional Comments/SuggestionsHow can this program be improved? (Please list both strengths and weaknesses.)Based on your educational needs, please provide us with suggestions for future program topics and formats:
