© FMOQ | MAJ 12-2015

EVALUATION FORM (CONFERENCES)Please complete this questionnaire and hand it in before leaving. Thank you!

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© FMOQ | MAJ 12-2015

EVALUATION FORM (CONFERENCES)

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© FMOQ | MAJ 12-2015

EVALUATION FORM (CONFERENCES)

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Disclosure of Conflicts of Interest Yes No

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* Commercial bias present, specify: __________________________________________________________

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Disclosure of Conflicts of Interest Yes No

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* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

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© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

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Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________

© FMOQ | MAJ 12-2015

suiteEVALUATION FORM (CONFERENCES)

Excellent Good Fair Poor

Relevant content

Objectives achieved

Clear presentation

Presenter’s communication skills

Interaction

Documentation

Disclosure of Conflicts of Interest Yes No

Commercial bias present Yes * No

Confirm my practice Changed my practice

* Commercial bias present, specify: __________________________________________________________

Topic(s) and presenter(s) :Topic: _____________________________ Presenter: _____________________________________

Comments: ________________________________________________________________________