Evaluation Form Survey

Question Title

* 2. Specialty (please select one):

Psychiatrist

Neurologist

Geriatrician

Primary Care Physician

Physician Assistant

Nurse (please specify below)

Other (please specify)

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* 3. Please enter your information below

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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NPI Number

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* 4. Please answer each statement by checking the rating under the heading that best describes your views:

	Excellent	Very Good	Good	Adequate	Poor	Very Poor
This presentation represented educational value for time spent	This presentation represented educational value for time spent Excellent	This presentation represented educational value for time spent Very Good	This presentation represented educational value for time spent Good	This presentation represented educational value for time spent Adequate	This presentation represented educational value for time spent Poor	This presentation represented educational value for time spent Very Poor
Please rate the effectiveness of Jason Kellogg's presentation	Please rate the effectiveness of Jason Kellogg's presentation Excellent	Please rate the effectiveness of Jason Kellogg's presentation Very Good	Please rate the effectiveness of Jason Kellogg's presentation Good	Please rate the effectiveness of Jason Kellogg's presentation Adequate	Please rate the effectiveness of Jason Kellogg's presentation Poor	Please rate the effectiveness of Jason Kellogg's presentation Very Poor

Question Title

* 5. Please answer each statement by clicking the circle that best describes how confident you are:

	Not Confident								Very Confident
Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented? Not Confident	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented?	Prior to the presentation, how confident were you in your understanding of the treatment presented? Very Confident
After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented? Not Confident	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented?	After the presentation, how confident are you in your understanding of the treatment presented? Very Confident
Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis? Not Confident	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	Prior to the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis? Very Confident
After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis? Not Confident	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis?	After the presentation, how confident were you in your understanding of hallucinations and delusions associated with Parkinson's disease psychosis? Very Confident

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* 6. After attending this program, will you use what you have learned in your day-to-day clinical practice?

Yes

Not Sure

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* 7. Were there any aspects that you felt should have been covered but were not addressed? (Please select all that apply)

Dosage and administration of the treatment presented

The proposed neurobiology for Parkinson's disease psychosis

Documentation of diagnosis, symptoms, and treatment for monitoring

Support for patients in long-term care, including CMS guidance pertaining to the indefinite use of the treatment presented without gradual dose reduction

Long-term safety data for the treatment presented

All topics were covered well

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Evaluation Form

GAPNA - September 30

Question Title

* 1. Enter your name:

Question Title

* 2. Specialty (please select one):

Question Title

* 3. Please enter your information below

Question Title

* 4. Please answer each statement by checking the rating under the heading that best describes your views:

Question Title

* 5. Please answer each statement by clicking the circle that best describes how confident you are:

Question Title

* 6. After attending this program, will you use what you have learned in your day-to-day clinical practice?

Question Title

* 7. Were there any aspects that you felt should have been covered but were not addressed? (Please select all that apply)