Exit this survey KY MOST & Advance Directives 1. Question Title * 1. I am a: Physician PA/NP RN Resident Medical Student Other (please specify) Question Title * 2. If you are wanting CME credits -- please provide your AAFP# or your name and city Question Title * 3. How would you rate this overall program on a scale of 1-5? Poor Below Average Average Above Average Excellent Question Title * 4. What degree do you feel the program will be clinically useful to your profession? None Somewhat Useful Useful Benefical Very Benefical Question Title * 5. Were you satisfied with the content of the Webinar? Yes No Comment Question Title * 6. What day(s) of the week work best for you? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Comment: Question Title * 7. What times work best for you? Morning before Noon Noon Afternoon before 6pm After 6pm Other (please specify) Question Title * 8. Did you have any technical difficulties? Yes No Comment Question Title * 9. What did you like best about this Webinar? Question Title * 10. What improvements would you suggest? Question Title * 11. What topics would you be interested? Question Title * 12. Final Comments? Question Title * 13. Name and Contact Info (Optional) Name: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: Done
