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Dementia ECHO 2nd Thursday Clinical

Cardea Services

Questions about this evaluation? Email info@cardeaservices.org.

We hope you found this educational offering both interesting and informative. Your anonymous responses will be used to plan future educational activities.

1. Please enter your unique identifying number using your birth month (mm), last two numbers of your cell phone number, and the first letter of your middle name. This number will be used to compare survey responses while keeping your responses anonymous.

Example: 0989S
Birth Month: September
Phone Number: 012-345-6789
Middle Name: Smith

3. Did you participate in a Clinical Dementia ECHO session in the last 2-3 months?
*This question is required.

Did you apply at least one approach or change in your practice as a result of the previous ECHO session? *This question is required.

4. Are you affiliated with IHS/Tribal/Urban or other workplace? *This question is required.

What is the name of your workplace?

5. What state do you currently work in? *This question is required.

6. Please list the number of tribes served by the facility you work in and/or tribal affiliation. *This question is required.

7. How satisfied are you with this learning activity?

Very satisfied	Satisfied	Unsatisfied	Very unsatisfied
Very satisfied	Satisfied	Unsatisfied	Very unsatisfied

8.  As a result of this learning activity, how has your knowledge on this topic changed? *This question is required.

Improved a lot	Improved a little	Stayed the same	Got worse
Improved a lot	Improved a little	Stayed the same	Got worse

9. Are you a provider who interacts with patients? *This question is required.

As a result of this learning activity, *This question is required.

Space Cell	Very likely	Likely	Unlikely	Very unlikely
my knowledge about driver screening and evaluation has increased.	my knowledge about driver screening and evaluation has increased.: Very likely	my knowledge about driver screening and evaluation has increased.: Likely	my knowledge about driver screening and evaluation has increased.: Unlikely	my knowledge about driver screening and evaluation has increased.: Very unlikely

10. I plan to make one change in practice based on what I learned in this activity. *This question is required.

Very likely	Likely	Unlikely	Very unlikely
Very likely	Likely	Unlikely	Very unlikely

Please describe any changes you plan to make in the work that you do. *This question is required.

Why are you unlikely to make a change? *This question is required.

Please enter an 'other' value for this selection.