BH NIVL Evaluation Form

Please score your agreement with or assessment of the following questions and statements by rating on a scale of 1 to 5, with 5 representing the highest level of satisfaction or agreement. *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree 0=Not applicable to my practice

	5	4	3	2	1	0
The information and/or skills learned will enhance my professional competence or ability.	The information and/or skills learned will enhance my professional competence or ability. - 5	The information and/or skills learned will enhance my professional competence or ability. - 4	The information and/or skills learned will enhance my professional competence or ability. - 3	The information and/or skills learned will enhance my professional competence or ability. - 2	The information and/or skills learned will enhance my professional competence or ability. - 1	The information and/or skills learned will enhance my professional competence or ability. - 0
This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients.	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 5	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 4	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 3	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 2	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 1	This activity conveyed information which will assist me in improving the health and/or treatment outcomes of of my patients. - 0

As a result of participating in this course, to what extent do you agree that you will be better able to accomplish these objectives *

Scoring Key: 5=Strongly Agree 4=Agree 3=Neutral 2=Disagree 1=Strongly Disagree 0=Not applicable to my practice

	5	4	3	2	1	0
Review results from various vascular cases.	Review results from various vascular cases. - 5	Review results from various vascular cases. - 4	Review results from various vascular cases. - 3	Review results from various vascular cases. - 2	Review results from various vascular cases. - 1	Review results from various vascular cases. - 0
Implement evidence-based strategies into clinical practice to improve care of the vascular patient.	Implement evidence-based strategies into clinical practice to improve care of the vascular patient. - 5	Implement evidence-based strategies into clinical practice to improve care of the vascular patient. - 4	Implement evidence-based strategies into clinical practice to improve care of the vascular patient. - 3	Implement evidence-based strategies into clinical practice to improve care of the vascular patient. - 2	Implement evidence-based strategies into clinical practice to improve care of the vascular patient. - 1	Implement evidence-based strategies into clinical practice to improve care of the vascular patient. - 0

Rate the following *

Scoring Key: 5=Excellent 4=Very Good 3=Good 2=Fair 1=Poor

	5	4	3	2	1
Course content.	Course content. - 5	Course content. - 4	Course content. - 3	Course content. - 2	Course content. - 1

Was this course fair, balanced and without commercial bias? *

Yes

No

If you checked "No,” please explain why: *

How many patients will you see in your practice who will likely be impacted by what you learned at this activity? *

1-5

6-10

Over 10

Not applicable to my practice

Name two strategies that you learned at this conference that you now plan to implement when you prescribe/perform and/or interpret PVL tests in order to improve patient care and outcomes *

What are the potential barriers or obstacles that might prevent you from implementing new strategies you learned at this conference? *

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