21632 AAI Fundamental Techniques Claim Credit

As a result of my participation in this activity, I am better able to:*

As a result of my participation in this activity, I am better able to:
	Strongly Agree	Agree	Disagree	Strongly Disagree
Identify and locate key anatomical structures as they apply to the safe and efficacious use of BoNTA and dermal filler injections.	As a result of my participation in this activity, I am better able to:: Identify and locate key anatomical structures as they apply to the safe and efficacious use of BoNTA and dermal filler injections. (Strongly Agree)	Identify and locate key anatomical structures as they apply to the safe and efficacious use of BoNTA and dermal filler injections. (Agree)	Identify and locate key anatomical structures as they apply to the safe and efficacious use of BoNTA and dermal filler injections. (Disagree)	Identify and locate key anatomical structures as they apply to the safe and efficacious use of BoNTA and dermal filler injections. (Strongly Disagree)
Select the BoNTA and/or filler product that provides the safest and most efficacious result for the targeted treatment site.	Select the BoNTA and/or filler product that provides the safest and most efficacious result for the targeted treatment site. (Strongly Agree)	Select the BoNTA and/or filler product that provides the safest and most efficacious result for the targeted treatment site. (Agree)	Select the BoNTA and/or filler product that provides the safest and most efficacious result for the targeted treatment site. (Disagree)	Select the BoNTA and/or filler product that provides the safest and most efficacious result for the targeted treatment site. (Strongly Disagree)
Implement safe and efficacious injection procedures and be able to recognize and implement appropriate treatment protocol of any potential adverse events.	Implement safe and efficacious injection procedures and be able to recognize and implement appropriate treatment protocol of any potential adverse events. (Strongly Agree)	Implement safe and efficacious injection procedures and be able to recognize and implement appropriate treatment protocol of any potential adverse events. (Agree)	Implement safe and efficacious injection procedures and be able to recognize and implement appropriate treatment protocol of any potential adverse events. (Disagree)	Implement safe and efficacious injection procedures and be able to recognize and implement appropriate treatment protocol of any potential adverse events. (Strongly Disagree)

The activity was appropriate and met my educational needs.*

Strongly Agree Agree Disagree Strongly disagree

What were your educational needs at the start of the activity? *

The following speaker(s) demonstrated experiential knowledge of the topic:

The following speaker(s) demonstrated experiential knowledge of the topic:
	Strongly Agree	Agree	Disagree	Strongly Disagree
TBD	The following speaker(s) demonstrated experiential knowledge of the topic:: TBD (Strongly Agree)	TBD (Agree)	TBD (Disagree)	TBD (Strongly Disagree)

Please indicate the extent of your agreement with the following statements: *

Please indicate the extent of your agreement with the following statements:
	Strongly Agree	Agree	Disagree	Strongly Disagree
The educational materials were effective..	Please indicate the extent of your agreement with the following statements: : The educational materials were effective.. (Strongly Agree)	The educational materials were effective.. (Agree)	The educational materials were effective.. (Disagree)	The educational materials were effective.. (Strongly Disagree)
The faculty was knowledgeable, effective and free of bias.	The faculty was knowledgeable, effective and free of bias. (Strongly Agree)	The faculty was knowledgeable, effective and free of bias. (Agree)	The faculty was knowledgeable, effective and free of bias. (Disagree)	The faculty was knowledgeable, effective and free of bias. (Strongly Disagree)
The learning activities were effective and incorporated active learning methods.	The learning activities were effective and incorporated active learning methods. (Strongly Agree)	The learning activities were effective and incorporated active learning methods. (Agree)	The learning activities were effective and incorporated active learning methods. (Disagree)	The learning activities were effective and incorporated active learning methods. (Strongly Disagree)
The content provided a fair and balanced coverage of the topic.	The content provided a fair and balanced coverage of the topic. (Strongly Agree)	The content provided a fair and balanced coverage of the topic. (Agree)	The content provided a fair and balanced coverage of the topic. (Disagree)	The content provided a fair and balanced coverage of the topic. (Strongly Disagree)
The information presented at this activity was pertinent to my professional needs	The information presented at this activity was pertinent to my professional needs (Strongly Agree)	The information presented at this activity was pertinent to my professional needs (Agree)	The information presented at this activity was pertinent to my professional needs (Disagree)	The information presented at this activity was pertinent to my professional needs (Strongly Disagree)
The information presented today was current.	The information presented today was current. (Strongly Agree)	The information presented today was current. (Agree)	The information presented today was current. (Disagree)	The information presented today was current. (Strongly Disagree)
The information was presented in a fair and balanced manner and examined the topic with scientific rigor.	The information was presented in a fair and balanced manner and examined the topic with scientific rigor. (Strongly Agree)	The information was presented in a fair and balanced manner and examined the topic with scientific rigor. (Agree)	The information was presented in a fair and balanced manner and examined the topic with scientific rigor. (Disagree)	The information was presented in a fair and balanced manner and examined the topic with scientific rigor. (Strongly Disagree)
The activity was well organized and well managed.	The activity was well organized and well managed. (Strongly Agree)	The activity was well organized and well managed. (Agree)	The activity was well organized and well managed. (Disagree)	The activity was well organized and well managed. (Strongly Disagree)
The content of this activity contributes valuable information that will assist me in improving patient outcomes.	The content of this activity contributes valuable information that will assist me in improving patient outcomes. (Strongly Agree)	The content of this activity contributes valuable information that will assist me in improving patient outcomes. (Agree)	The content of this activity contributes valuable information that will assist me in improving patient outcomes. (Disagree)	The content of this activity contributes valuable information that will assist me in improving patient outcomes. (Strongly Disagree)
Based on my experience today, I would recommend future activities on Combined Use of BoNTA and Dermal Fillers similar to this to my colleagues.	Based on my experience today, I would recommend future activities on Combined Use of BoNTA and Dermal Fillers similar to this to my colleagues. (Strongly Agree)	Based on my experience today, I would recommend future activities on Combined Use of BoNTA and Dermal Fillers similar to this to my colleagues. (Agree)	Based on my experience today, I would recommend future activities on Combined Use of BoNTA and Dermal Fillers similar to this to my colleagues. (Disagree)	Based on my experience today, I would recommend future activities on Combined Use of BoNTA and Dermal Fillers similar to this to my colleagues. (Strongly Disagree)
The teaching and learning methods were effective	The teaching and learning methods were effective (Strongly Agree)	The teaching and learning methods were effective (Agree)	The teaching and learning methods were effective (Disagree)	The teaching and learning methods were effective (Strongly Disagree)
The learning assessment used for this activity was appropriate	The learning assessment used for this activity was appropriate (Strongly Agree)	The learning assessment used for this activity was appropriate (Agree)	The learning assessment used for this activity was appropriate (Disagree)	The learning assessment used for this activity was appropriate (Strongly Disagree)
	(Strongly Agree)	(Agree)	(Disagree)	(Strongly Disagree)

Please rate the following:*

Please rate the following:
	Excellent	Good	Fair	Poor
What was your overall rating of the speaker/instructor?	Please rate the following:: What was your overall rating of the speaker/instructor? (Excellent)	What was your overall rating of the speaker/instructor? (Good)	What was your overall rating of the speaker/instructor? (Fair)	What was your overall rating of the speaker/instructor? (Poor)

Did the speakers encourage questions/discussions or other participation from the audience? *

Yes No

If no, please provide a detailed explanation:*

The content was objective, current, scientifically sound and free of commercial bias*

Yes No

If no, please describe the factors that contributed to the bias:*

Based on information presented in the activity, I will: *

Do nothing because content was not convincing Seek additional information on this topic Change my practice Do nothing as current practice reflects activity recommendations Do nothing as lack of organizational support prevents my adoption of presented guidelines and recommendations Do nothing as lack of financial support prevents my adoption of presented guidelines and recommendations

Other:

As a result of this course, I will likely make changes to my practice in these categories:*

Diagnosis Patient Safety Documentation (appropriate) Treatment approach Patient Education Medication

The most important takeaway I’ve learned from this activity:*

As a result of my participation in this activity, I plan to make the following change in my role on the healthcare team:*

Based on the objectives above and participation in the activity, my healthcare team will make the following changes in practice:*

Of the patients you will see in the next week, about how many will benefit from the information you learned today?*

More than 50 26 to 50 11 to 25 1 to 10 Not applicable

Based on what I learned today, I will improve my practice by incorporating the following (check all that apply): *

Improved diagnosis/patient assessment Useful therapies and appropriate uses Cutting-edge science in this therapeutic area Best practices of my colleagues and leaders I do not plan to make any changes to my practice at this time

Other:

Which ONE delivery method do you find the most effective for CE learning? *

Live symposia at national/regional conferences Live local meetings Live grand rounds Internet webcasts Internet/print monographs

Other:

Please rate the professional practice value of each of the following in terms of improving your practice:*

Please rate the professional practice value of each of the following in terms of improving your practice:
	Most Valuable	Valuable	Somewhat Valuable	Least Valuable
Today’s CE event	Please rate the professional practice value of each of the following in terms of improving your practice:: Today’s CE event (Most Valuable)	Today’s CE event (Valuable)	Today’s CE event (Somewhat Valuable)	Today’s CE event (Least Valuable)
Direct to consumer advertising	Direct to consumer advertising (Most Valuable)	Direct to consumer advertising (Valuable)	Direct to consumer advertising (Somewhat Valuable)	Direct to consumer advertising (Least Valuable)
Sales representative visits	Sales representative visits (Most Valuable)	Sales representative visits (Valuable)	Sales representative visits (Somewhat Valuable)	Sales representative visits (Least Valuable)
Promotional/other non-certified education	Promotional/other non-certified education (Most Valuable)	Promotional/other non-certified education (Valuable)	Promotional/other non-certified education (Somewhat Valuable)	Promotional/other non-certified education (Least Valuable)

What motivated you to participate in this activity? *

CE credits Faculty Topic or Therapeutic area Format type

Based upon the information presented in this educational activity, which of the following statements best reflects your sentiment toward education for Combined Use of Dermal Fillers and BoNTA for Facial Enhancement: Fundamental Techniques? (select one)*

I have learned everything I need to learn about Combined Use of Dermal Fillers and BoNTA for Facial Enhancement: Fundamental Techniques. I would like to learn more about Combined Use of Dermal Fillers and BoNTA for Facial Enhancement: Fundamental Techniques.

We would be interested in using your topic suggestions as a means to develop future education. What general comments or additional topics would you suggest for future activities?*

Can we share your opinions/comments regarding this course for promotional purposes?*

Yes No

Other comments or suggestions for improvement?*

Please select the hours you attended*

8:00am – 12:00pm Didactic Lecture on Dermal Fillers and Botulinum Toxins 12:30pm – 5:00pm Hands-On Training for Dermal Fillers and Botulinum Toxins with Live Injections, Review, Discussion, Q&A

Total Symposium CE Hours*

Rough Total Symposium CME Hours

Minutes in a Hour

M=CME

Y=CME

Q=CME