Thank you for watching the Annual Wellness Visit webinar! After you successfully complete the evaluation and the reflective questions, you will access your certificate that includes continuing education credits. Thanks again!

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* 1. Last Name

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* 2. First Name

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* 3. Email Address

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* 4. Discipline

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* 5. Organization Name

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* 6. CCN # (if applicable)

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* 7. NPI # (if applicable)

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* 8. Zip Code

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* 9. Select the best description of your work setting:

Evaluation

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* 10. Instructions: Use the drop down boxes to rate your ability to demonstrate each of the following objectives before and after the education. If using mobile device, make sure to scroll to the right to see both columns.

  BEFORE AFTER
Identify Annual Wellness Visit (AWV) components
State who can conduct an AWV
Describe AWV assessments for nursing home residents

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* 11. The presentation style of the speaker(s) contributed to my learning experience.

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* 12. I will be able to apply what I learned on the job immediately using a scale of 1 (not at all) to 5 (absolutely).

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* 13. Click on a star rating for your overall experience with this webinar course. (1 to 5 stars)

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* 14. How are you going to integrate the Annual Wellness Visit components into your day-to-day practice to ensure they are complete?

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* 15. Provide a short statement of the value of the Annual Wellness Visit that you could share with your patients/residents?

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* 16. Who currently completes the Annual Wellness Visit at your practice/facility? Now knowing all the disciplines that can conduct the visit, will you add others? 

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* 17. Other Comments:

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