Healthcare Provider Presentation Survey

Missouri Poison Center

The Missouri Poison Center is pleased to assist you as we educate you about the care of the poisoned patient. We are an Accredited Regional Poison Center, providing services to the state of Missouri. We are staffed by Registered Nurses and Pharmacists who have acute care and critical care experience, and are specially trained and certified as poison information specialists. Our physician is a board certified medical toxicologist.

In an attempt to improve the value of our services, we would like to ask you to answer the questions below. All comments are welcome!

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* 1. How would you describe the quality of the presentation you received from the Poison Center Specialist?

5 Excellent

3 Acceptable

1 Poor

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* 2. Please rate the presentation based on the following criteria:

	5 Excellent	4	3 Acceptable	2	1 Poor	Nonapplicable
Beneficial	Beneficial 5 Excellent	Beneficial 4	Beneficial 3 Acceptable	Beneficial 2	Beneficial 1 Poor	Beneficial Nonapplicable
Well Organized	Well Organized 5 Excellent	Well Organized 4	Well Organized 3 Acceptable	Well Organized 2	Well Organized 1 Poor	Well Organized Nonapplicable
Informative	Informative 5 Excellent	Informative 4	Informative 3 Acceptable	Informative 2	Informative 1 Poor	Informative Nonapplicable

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* 3. Did you learn any new toxicology information that can be applied to your job or work duties from this presentation

Yes

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* 4. Do you think that the presenter was confident about the about the subject matter presented?

5 Very Much So

3 Acceptable

1 Not At All

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* 5. Did you feel the content presented was appropriate for the allotted time?

Yes

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* 6. Please enter the name/topic of the presentation evaluated.

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* 7. Please enter the venue where you attended the presentation.

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* 8. Please let us know of any comments you would like to make about your Poison Center experience. We are happy to listen!

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* 9. (Optional) Please provide your name and preferred method of contact if you would like to be reached by the Missouri Poison Center.

Name:

Email Address:

Phone Number: