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Sexual Health in Older Adults
Program Evaluation
We appreciate your participation in this continuing education activity. Your responses to our survey w
ill allow us to improve our program offerings and services.
T
hank you for your time!
For each statement provided below, please circle the number on the 1 to 5 scale that best reflects your opinions about today’s conference.
Using the scale: 1= Strongly Disagree 2= Disagree 3= Somewhat Agree 4= Agree 5= Strongly Agree
*
I feel that as a result of this activity I will be better able to:
(Required.)
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
Review how to take a sexual history from a patient over 65
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
Discuss common misconceptions and biases regarding older adults
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
Review disorders of sexual desire in older adults
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
Explain how to gather a history and appropriately prescribe for erectile dysfunction in older men
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
*
For each statement provided below, please check the number on the 1 to 5 scale that best reflects your opinions about today’s conference.
(Required.)
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
There was enough time to cover the topic
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
I would recommend this conference to my peers
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
The information was applicable to my daily activities
Strongly Disagree
1
Diagree
2
Somewhat Agree
3
Agree
4
Strongly Agree
5
*
What were the major strengths of today’s conference?
(Required.)
Describe any perceived commercial bias.
*
Was today’s topic one that you would have identified as important to you?
(Required.)
Yes
No
*
Amount of time I spent at this activity:
(Required.)
15 minutes
30 minutes
45 minutes
60 minutes
Please share any additional comments and suggestions. Your feedback is extremely valuable to us.
*
Please indicate what type of CE credit you are requesting:
(Required.)
Nursing
Social Work
Medicine
Licensed Mental Health Counselor
Certificate of Attendance
Please list your information below so we may send you a Certificate:
Name and Credentials
Company
State
Email Address