Post Test

Final Test

Domestic Violence

Do to possible and/or frequent changes in requirements established by the State of Florida regarding Domestic Violence education, this home study is null and void if not returned by July 2010.

How to use this answer form:

Please fill out the following information, then answer the questions and evaluation. It is also advisable to keep a copy of your submitted answers, in case of internet errors that may interfere with delivery.

There are two possible ways to have your answers be graded:

1. Print out this page and send it in along with payment (if applicable) to MECOP.

                          Mail or FAX to:

                                Medical Educational Council of Pensacola
                          8880 University Pkwy Suite C,
                          Pensacola, Florida 32514
                          FAX: (850)477-8144
                          Phone: (850) 477-4956

2. Submit the answers over the internet along with your credit card information.

MECOP will grade this within 1-2 days and, if grade was 80% or better, will send a Certificate of Completion upon receipt of check or credit card number. The fee for this educational activity is $25.00. Make checks payable to MECOP. If grade was less than 80%, MECOP will call or email you of your score and allow you to retake the test.

* Required Fields

*Specialty:
Other:

*Name (as you would like it on your Certificate of Completion)

Title: (M.D., D.O., etc) *E-mail

*Day Phone ()- FAX ()-

*Address

*City

*State *ZIP Code -

*Method of Payment:
I will be sending in a check for $25.00

Please charge my credit card, listed below.

Credit Card: Visa Master Card American Express

Card# Expiration Date: Amount:

Please enter your answers to the questions below:

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Program Evaluation Summary The purposes of this form include 1) course evaluation 2) assist in identifying topics for future programs 3) fulfilling requirements for continued category 1 CME approval.
This Program:
This Program:	Not at all	Somewhat	Very Much
Helped me maintain current abilities and/or knowledge
Helped keep me abreast of new developments
Developed new professional skills and/or knowledge
Enhanced my confidence in my professional situation
Will help me be more effective/productive
Met my expectations
Used effective methods of information transfer
Was well-conceived/organized/produced
Met its stated goal
Please take another moment to answer the questions below. It will assist in identifying future topics for CME offerings. Suggestions/remarks concerning this program: Suggestions for future programs: Please list a behavioral technique or piece of information that has changed as a result of this program: