Project ECHO Anonymous Feedback Form

Overview

Thank you for taking a moment to provide feedback for the Project ECHO team! This short survey will be 100% anonymous unless you choose to include your contact information. We welcome your uncensored feedback because that's the only way we will know how to best format our program to meet your needs.

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* 1. Which Project ECHO Clinic are you providing feedback on?

Antibiotic Stewardship

Behavioral Health in Primary Care

Diabetes and General Endocrine

Gastroenterology

Geriatric

Pain Management

Public Health

Special Series

Sports Medicine

Other (please specify)

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* 2. What do you find most HELPFUL about the Project ECHO Clinic(s) you participate in?

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* 3. Please provide suggestions for IMPROVING the Project ECHO Clinic(s) you participate in?

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* 4. Please feel free to share any additional comments?

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* 5. OPTIONAL: Contact Information

Name

Organization

City/Town

State

ZIP

Country

Email Address

Phone Number