Men's Health Toolkit Reporting Form Men's Health Toolkit Reporting Form Question Title * 1. Name of Chapter (Required.) Question Title * 2. Submitted By (Required.) Question Title * 3. Date of Event (Required.) Date / Time Date Question Title * 4. Topic Discussed (Required.) Gun Violence/Trauma Prostate Health/Erectile Dysfunction Cardiovascular Health/Myocardial Infarction HIV Prevention Smoking Cessation Question Title * 5. Total Number of Attendees (Required.) Question Title * 6. Total Number of Male attendees (Required.) Question Title * 7. How would you rate the content provided on the topic in this toolkit? (Required.) Not Important Minimally Important Moderately Imporant Extremely Important Not Important Minimally Important Moderately Imporant Extremely Important Question Title * 8. How likely are you to make changes to practice based on information provided? (Required.) Highly Unlikely Unlikely Neutral Likely Highly Likely Highly Unlikely Unlikely Neutral Likely Highly Likely Question Title * 9. How likely are you to share information presented today? (Required.) Highly Unlikely Unlikely Neutral Likely Highly Likely Highly Unlikely Unlikely Neutral Likely Highly Likely Question Title * 10. How likely are you to use this toolkit again? (Required.) Highly Unlikely Unlikely Neutral Likely Highly Likely Highly Unlikely Unlikely Neutral Likely Highly Likely Question Title * 11. How likely are you to recommended this toolkit to a colleague? (Required.) Highle Unlikely Unlikely Neutral Likely Highly Likely Highle Unlikely Unlikely Neutral Likely Highly Likely Done