1. Please take a few minutes to give some feedback about your experience with this course.

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* 1. ABOUT YOU (Optional)

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* 2. VISIT DATE

DATE

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* 3. WHO WAS TRAINED DURING THE PAL'S VISIT?

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* 4. WHO WAS THE PHYSICIAN APPLICATION LIAISON?

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* 5. WHAT SERVICES WERE PROVIDED DURING THE PAL VISIT?

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* 6. ABOUT YOUR EXPERIENCE (Required)

  Strongly Agree Agree Neutral Disagree Strongly Disagree
My overall experience was positive.
The Traveling Physician Application Liaison demonstrated knowledge of the subject.
The visit objectives were covered by the Traveling Physician Application Liaison as outlined at the start of the visit.
Do you feel this visit will increase the efficiency of your office?
If you need additional assistance with the Meridian Clinical System will you call your Traveling Physician Application Liaison again?
The duration of the visit was appropriate.

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* 7. Please comment on the Physician Application Liaison's regard to effectiveness.(Optional)

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* 8. Please comment on the strengths and weakness of the visit. (i.e. class length, content etc). (Optional)

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* 9. Is there anything else we should include in this visit? (Optional)

T