Infant-Driven Feeding™: Advancing Oral Feeding Practice in the NICU EVALUATION

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* 1. Contact Information

First name

Last Name

Full name of hospital/company

State/Province

Email Address

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* 2. If you are a speech pathologist and would like ASHA CEUs, the following additional information is REQUIRED. If the information below is incomplete, you WILL NOT be awarded CEUs for this course.

ASHA ID

Home address Street and Box/Apt no if applicable

Home address City

Home address State

Home address Zip code

Home address Country

Email address associated with your ASHA Account

Course Completion Date (xx/xx/xxxx)

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* 3. What is your discipline?

Nurse

Physician

Physical therapist

Occupational therapist

Speech Pathologist

Nutritionist

Lactation Consultant

Other (please specify)

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* 4. How many years of NICU experience do you have?

0-5

6-10

11-15

More than 15

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* 5. How would you rate the course in meeting the stated objectives for this topic?

Poor

Fair

Average

Good

Excellent

Poor

Fair

Average

Good

Excellent

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* 6. How would you rate the content on presenting the material at an appropriate level?

Poor

Fair

Average

Good

Excellent

Poor

Fair

Average

Good

Excellent

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* 7. How would you rate the content on being accurate and current?

Poor

Fair

Average

Good

Excellent

Poor

Fair

Average

Good

Excellent

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* 8. How would you rate the course format on being engaging and easy to follow?

Poor

Fair

Average

Good

Excellent

Poor

Fair

Average

Good

Excellent

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* 9. How long did it take you to complete the course?

0-1 hours

1-2 hours

2-3 hours

3-4 hours

4-5 hours

5-6 hours

Other (please specify)

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* 10. Were you provided disclosure of financial relationships between faculty and commercial entities and find lecture without bias in favor of product?

Yes

Neutral

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* 11. How did you access the program? Check all that apply.

Hospital computer

Home computer

Tablet

Phone

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* 12. The learning platform was easy to use - True or False?

True

False

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* 13. What are your goals for taking the Infant-Driven Feeding™ Course? Check all that apply.

Individual interest and knowledge

Interest in sharing knowledge learned with my team

Investigation of the program for possible team purchase in the future

Required by my facility as part of our team

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* 14. What change will you make in your practice as a result of this learning activity?

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* 15. What topic(s) would you like to have presented in the future?

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* 16. How likely is it that you would recommend the Infant-Driven Feeding™ Program to a friend or colleague?

NOT AT ALL LIKELY

EXTREMELY LIKELY

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* 17. Please provide any additional feedback you would like us to know about your experience:

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* 18. Please check YES if you would like to receive emails in the future regarding Dr. Brown's Medical and Infant-Driven Feeding™. Your email is always safe with us and will never be provided to a third party.

YES