Speaker Assessment: Day, Month, Year *

Please rate the overall quality of the presentation:

	Very Low	Low	Moderate	High	Very High
Title_Speaker	Title_Speaker - Very Low	Title_Speaker - Low	Title_Speaker - Moderate	Title_Speaker - High	Title_Speaker - Very High

Overall Activity Assessment: *

	Very Low	Low	Moderate	High	Very High
To what extent were you satisfied with the overall quality of the activity?	To what extent were you satisfied with the overall quality of the activity? - Very Low	To what extent were you satisfied with the overall quality of the activity? - Low	To what extent were you satisfied with the overall quality of the activity? - Moderate	To what extent were you satisfied with the overall quality of the activity? - High	To what extent were you satisfied with the overall quality of the activity? - Very High
To what extent was the content of the program relevant to your practice?	To what extent was the content of the program relevant to your practice? - Very Low	To what extent was the content of the program relevant to your practice? - Low	To what extent was the content of the program relevant to your practice? - Moderate	To what extent was the content of the program relevant to your practice? - High	To what extent was the content of the program relevant to your practice? - Very High
To what extent will you make a change in practice/professional responsibilities?	To what extent will you make a change in practice/professional responsibilities? - Very Low	To what extent will you make a change in practice/professional responsibilities? - Low	To what extent will you make a change in practice/professional responsibilities? - Moderate	To what extent will you make a change in practice/professional responsibilities? - High	To what extent will you make a change in practice/professional responsibilities? - Very High
As a result of participating in this activity, xxxxxxxxxxxx	As a result of participating in this activity, xxxxxxxxxxxx - Very Low	As a result of participating in this activity, xxxxxxxxxxxx - Low	As a result of participating in this activity, xxxxxxxxxxxx - Moderate	As a result of participating in this activity, xxxxxxxxxxxx - High	As a result of participating in this activity, xxxxxxxxxxxx - Very High
As a result of participation in this activity, xxxxxxxxxxxx.	As a result of participation in this activity, xxxxxxxxxxxx. - Very Low	As a result of participation in this activity, xxxxxxxxxxxx. - Low	As a result of participation in this activity, xxxxxxxxxxxx. - Moderate	As a result of participation in this activity, xxxxxxxxxxxx. - High	As a result of participation in this activity, xxxxxxxxxxxx. - Very High

Did this activity present scientifically rigorous, unbiased, and balanced information? *

Yes

No, please describe:

Did this activity present scientifically rigorous, unbiased, and balanced information? No, please describe:

List 2 or more changes you will implement into your practice as a result of participation in this activity: *

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