Total Joint Replacement Class Completion Page

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* 1. Did you complete this class?

Yes

No ( Please explain why.)

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* 2. What is your first name?

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* 3. What is your last name?

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* 4. Are you scheduled for surgery at Memorial Medical Center? If yes, what is the date of your surgery? If no, please explain why you attended today's class.

Yes

No

If yes, what is your scheduled surgery date? If no, please explain why you attended today's class.

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* 5. Thank you for completing this course. What did you find most useful in this class?

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* 6. What did you find least useful in this class?

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* 7. Do you have any suggestions for improvement?