Fields marked with an asterisk * are required.

* Name

* Address

* Contact Phone

Email Address

* Qa / CME Number

How did you experience this program?
Live Broadcast (please specify venue):

Repeat Broadcast (please specify venue):

Online Video Webstreaming
DVD or VHS video
Audio Podcast

To which professional group or groups do you belong?
(please include ALL attendees, not just those wishing to access accreditation.)
GPs
Pharmacists
Specialists (please specify):

Nurses
Drug and Alcohol Workers
Community Health Workers
Aboriginal Health Workers
Allied Health
Researchers
Advocates / Peak Bodies
Carers
Consumer
Other (please specify):

How did you hear about the program?
(please select all that apply)
Direct invitation
Division of General Practice
Rural Health Education Foundation website
Newsletter / Journal
Previous broadcast
Department of Health and Ageing
Other Peak Body Association (please specify):

Rural Health Education Foundation site coordinator
Other (please specify):

a. To what extent will the program influence the way you practise medicine or health care?
(please select one)
Significant Influence
Some Influence
Minimal Influence
Not at all

b. Please rate the program 1-5 (1=lowest) on the following criteria:

c. Please indicate whether the learning objectives were met.

* OBJECTIVE 1:  Understand the potential impact on the unborn child of drinking alcohol in pregnancy.
Met
Not met
Comments:

* OBJECTIVE 2:  Recognise the ongoing developmental consequences for a child with FASD.
Met
Not met
Comments:

* OBJECTIVE 3:  Identify the issues for ongoing management and support for a child or adult with FASD.
Met
Not met
Comments:

* OBJECTIVE 4:  Identify the links between education, health professionals and community involvement when enabling preventative strategies for FASD.
Met
Not met
Comments:

* d. What changes, if any, would you consider making to your work practices as a result of this program?

e. What comments do you have about the presentation style of this program: panel discussion, presentations, demonstrations, case studies, etc?

f. Please give two examples of how you might incorporate this resource into an educational event or program.

g. Are there any other topics you would like addressed by the Rural Health Education Foundation, either related to this program or any other areas of interest?

Thank you for taking the time to complete this evaluation form.