Questions marked with an asterisk (*) are mandatory.

1	* Please rate the effectiveness of this presentation by checking the appropriate number: (1= lowest, 5= highest) 1   2   3   4   5   Usefulness of the information in your clinical work. Objectiveness/balance of information. Presentation met learning objectives (see above). Overall rating of presentation.

2	Please use the area below to provide additional feedback about the speaker(s) and presentation.

3	Please offer suggestions for future educational events or other comments.

4	* This section MUST be completed and submitted in order for you to receive continuing education credit: Name Practice Address 1 Address 2 City/Town State/Province Zip/Postal Code Credentials (i.e. MD) Email Address

5	Phone number: