The Crohn’s & Colitis Foundation is eager to receive your feedback on the IBD Pro: Tampa Bay program held on June 8, 2024, and we require this completed form to issue your CME credits. Your insights will help us determine program content and improvements for future programs. Thank you for your participation.

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* Full Name

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* Primary Professional Credential:

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* After attending this program, I plan to make the following changes to my practice:
(Check all that apply)

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* This program will help me improve my practice in the following areas:
(Check all that apply)

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* How many CME credits are you claiming?
(Maximum of 4 credits. Claim only the credit(s) commensurate with the extent of your participation in the activity.)

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* Name as appears on license:

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* Degree/Credential as appears on license:

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* License Number:

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* State of License:
(Example: FL)

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* Professional Email:

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* Month of Birth:

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* Day of Birth:

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* Was the content of this activity fair, balanced, objective, and free of bias?

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* Please select the extent to which you agree/disagree that the activity achieved the following:

  Strongly Agree Agree Neutral Disagree Strongly Disagree
The faculty were effective in presenting the material
The content was evidence based
The educational material provided useful information for my practice
The activity enhanced my current knowledge base
The activity provided appropriate and effective opportunities for active learning (e.g., case studies, discussion, Q&A, etc.)
The opportunities provided to assess my own learning were appropriate (e.g., questions before, during or after the activity)
This activity improved my ability to function as part of the interprofessional care team

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* Please list any clinical issues/problems within your scope of practice you would like to see addressed in future educational activities:

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* Would you recommend the Crohn's & Colitis Foundation to your patients?

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* Are you engaged with your local Foundation chapter?

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* What type of programming would you like to attend in the future?
(Check all that apply)

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* Who would you like to hear from at future programming?
(Check all that apply)

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* What topics are you interested in learning more about?

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* Is accreditation important in your decision to participate in local education programming?

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* If yes, please select all types of accreditation that apply:

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* Certification Statement

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* Speaker Disclosures

Accreditation Statement:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Medical Association of Georgia through the joint providership of Southern Alliance for Physician Specialties CME and the Crohn’s & Colitis Foundation. The Southern Alliance for Physician Specialties CME is accredited by the Medical Association of Georgia to provide accredited continuing education for physicians.

For physicians only
Your attendance will be reported to ACCME, Program & Activity Reporting System (PARS).
The CME credits that physicians earn from this activity will be submitted to ACCME's CME Passport, a free, centralized web application where physicians can create a personalized account to view, track, and generate transcripts of their reported CME credit. Visit www.cmepassport.org to create an account.

For registered nurses only
You will receive a PDF of your certificate of accredited continuing education via email.

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