AACME Black Belt Please fill out and submit this evaluation to receive your certificate of completion. Question Title * 1. Contact Information Name Email Address OK Question Title * 2. The program increased my knowledge and recent developments in patient centered healthcare Strongly agree Somewhat agree Neither agree nor disagree Somewhat disagree Strongly disagree OK Question Title * 3. Which of the following course features attracted you to this program? Educational format Site Cost Presenters Accreditation OK Question Title * 4. Please indicate any barriers that might prevent you from applying the knowledge gained from this meeting to your practice. Lack of time Lack of experience Lack of opportunity (patients) Lack of resources (equipment, staff) Reimbursement / insurance issues No barriers Other, please specify (i.e. cost to implement, regulatory concerns etc.) OK Question Title * 5. How will you change your practice as a result of attending this activity? I will create/revise protocols, policies, and/or procedures I will change the management and/or treatment of my patients I will not make any changes to my practice Other (please specify) OK Question Title * 6. Would you recommend this program to your colleagues? Yes No OK DONE