DHPD - Improving the Oral Health of Pregnant Women, Children & Families Evaluation

Question Title

1. Today's Date:

Date

Question Title

2. Which type(s) of certificate would you like?

CHW/CHR Certificate (5.75 Units from the New Mexico Department of Health)

Continuing Medical Education Certificate for Physicians (6.25 Units)

Continuing Medical Education Certificate for Non-Physicians (6.25 Units)

Not Applicable (not requesting CEUs or CMEs)

Question Title

3. Please provide your name and email address if you are requesting CEUs or CMEs.

Name

Email Address

Question Title

4. What is your role?

Community Health Worker (CHW)

Community Health Representative (CHR)

Other (please specify)

Question Title

5. Which county do you serve? (If multiple, choose primary county)

Question Title

6. Training Objectives and Content

	Strongly Agree	Agree	Disagree	Strongly Disagree
The objectives of this session were clearly explained	The objectives of this session were clearly explained Strongly Agree	The objectives of this session were clearly explained Agree	The objectives of this session were clearly explained Disagree	The objectives of this session were clearly explained Strongly Disagree
Overall the session met its objectives	Overall the session met its objectives Strongly Agree	Overall the session met its objectives Agree	Overall the session met its objectives Disagree	Overall the session met its objectives Strongly Disagree

Question Title

7. Because I attended this training:

	Strongly Agree	Agree	Disagree	Strongly Disagree
I have gained valuable knowledge and skills	I have gained valuable knowledge and skills Strongly Agree	I have gained valuable knowledge and skills Agree	I have gained valuable knowledge and skills Disagree	I have gained valuable knowledge and skills Strongly Disagree
There will be a positive impact on my professional work	There will be a positive impact on my professional work Strongly Agree	There will be a positive impact on my professional work Agree	There will be a positive impact on my professional work Disagree	There will be a positive impact on my professional work Strongly Disagree

Question Title

8. Overall, I am satisfied with the training.

Strongly Agree

Agree

Disagree

Strongly Disagree

Strongly Agree

Agree

Disagree

Strongly Disagree

Question Title

9. Do you feel this presentation conveyed any commercial bias?

Yes

DHPD - Improving the Oral Health of Pregnant Women, Children & Families Evaluation

Question Title

1. Today's Date:

Question Title

2. Which type(s) of certificate would you like?

Question Title

3. Please provide your name and email address if you are requesting CEUs or CMEs.

Question Title

4. What is your role?

Question Title

5. Which county do you serve? (If multiple, choose primary county)

Question Title

6. Training Objectives and Content

Question Title

7. Because I attended this training:

Question Title

8. Overall, I am satisfied with the training.

Question Title

9. Do you feel this presentation conveyed any commercial bias?

Question Title

10. Can you think of changes you might make to your professional practice as a result of this training?

Question Title

11. What do you think some of the barriers will be to making changes in your practice?

Question Title

* 1. Today's Date:

Question Title

* 2. Which type(s) of certificate would you like?

Question Title

* 3. Please provide your name and email address if you are requesting CEUs or CMEs.

Question Title

* 4. What is your role?

Question Title

* 5. Which county do you serve? (If multiple, choose primary county)

Question Title

* 6. Training Objectives and Content

Question Title

* 7. Because I attended this training:

Question Title

* 8. Overall, I am satisfied with the training.

Question Title

* 9. Do you feel this presentation conveyed any commercial bias?

Question Title

* 10. Can you think of changes you might make to your professional practice as a result of this training?

Question Title

* 11. What do you think some of the barriers will be to making changes in your practice?

1. Today's Date:

2. Which type(s) of certificate would you like?

3. Please provide your name and email address if you are requesting CEUs or CMEs.

4. What is your role?

5. Which county do you serve? (If multiple, choose primary county)

6. Training Objectives and Content

7. Because I attended this training:

8. Overall, I am satisfied with the training.

9. Do you feel this presentation conveyed any commercial bias?

10. Can you think of changes you might make to your professional practice as a result of this training?

11. What do you think some of the barriers will be to making changes in your practice?