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* 1. Last Name:

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* 2. E-mail Address:

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* 3. Disclosure of relevant conflicts of interest for individuals in control content was provided in advance of my participation in the accredited education

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* 4. Disclosure of whether or not there was commercial support received from ACCME defined commercial interests was provided in advance of my participation in the accredited education

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* 5. The learning objectives were actionable and measurable and supported by the activity content

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* 6. The activity format was appropriate for the setting and relevant to my practice

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* 7. The activity content was fair balanced and free of bias

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* 8. Scientific studies cited within the activity conform to standards acceptable by the scientific community

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* 9. Are there any issues you would like to raise regarding the activity content?

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* 10. Will you make changes in your practice because of your participation in the activity?

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