November 1, 2017 (Tempe, AZ)

Thank you for attending the screening of the documentary, "Defining Hope" and the Q&A Session that followed.  If you would like to receive Social Work contact hours for participating in this program, please ensure you signed in at the event and then complete the following evaluation and a certificate will be emailed to you. 

If you have questions, please contact the AHPCO office at 480-491-0540.  For more information about AHPCO, please visit us online at www.ahpco.org.
The overall goal/purpose of this program is to highlight the impact of caring for individuals at the end of life and its effect on our daily practice as healthcare professionals.

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* 1. Please respond to the following statements about the activity.  If you select “Disagree” or “Strongly Disagree,” please provide a comment below.

  Strongly Agree Agree Neutral Disagree Strongly Disagree
The overall purpose/goal for this activity was met. 
I found this activity worthwhile for my professional practice.
This activity will enhance my knowledge/skill as a health care provider.
The presenters were knowledgeable about the topic and provided the information in an interesting manner that facilitated my learning:

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* 2. As a result of this activity, please share at least one action you will take to change your professional practice.

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* 3. What other health care/professional topics would you like to see presented at a future AHPCO program?

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* 4. Please provide any additional comments you would like to share with the Planning Team.

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* 5. Name (Please enter exactly as it should be listed on the certificate including any credentials such as MSW, etc.)

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* 6. Email (please enter the email address where we can send the certificate - will be a PDF attachment).  Your email will only be used to send the certificate unless you request to be added to our mailing list in the next section.  If you prefer to pick up your certificate at our Tempe office, please type Pick Up in this field and then after submitting your evaluation, contact our office at 480-491-0540 to arrange an appointment.

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* 7. I would like to be added to the AHPCO mailing list so I may receive information about educational opportunities and resources for healthcare professionals caring for individuals with chronic and/or life-limiting conditions.

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