Thank you for watching the Empowering Your Patients to Control Diabetes 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. Practice Name

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* 6. CCN # (if applicable)

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* 7. NPI # (if applicable)

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* 8. Zip Code

Evaluation

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* 9. 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 patients within their practice who qualify for Diabetes Self-Management Education and Support (DSMES).
Describe the process of referring to your local DSMES program.
State two potential benefits of enrolling patients in DSMES.

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

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* 11. Was the course's supportive materials (e.g., handouts, teaching aides, visual aids, etc.) beneficial to your learning?

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* 12. Was the information provided in this course applicable to your job?

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* 13. 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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* 14. On a scale of 1 (low) to 5 (high), how familiar are you with the qualifying criteria for the DSMES program?

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* 15. Click on a star rating for your overall experience with this webinar course from 1 (low) to 5 (high). 

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* 16. Please provide any feedback or suggestions you may have:

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