Post-Test
Please fill out the following information, then answer the questions. 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 along with payment (if applicable) to MECOP.
Mail of Fax to:
Medical Educational Council of Pensacola 8880 University Parkway, Suite C, Pensacola, Florida 32514 Fax: (850)477-8144
2. Submit the answers over the internet and send payment in separately, (if applicable). You may also enter your credit card info in the supplied area.
MECOP will grade this within 1-2 days and, if grade was 70% of better, will send a Certificate of Completion upon receipt of check or credit card number. The fee for this educational activity is $60.00. Make checks payable to MECOP.
If grade was less than 70%, MECOP will call or email you of your score and allow you to retake the test. You will not be charged until you pass the test.
Specialty: Title: (M.D., D.O., etc) Name (as you would like it on the certificate) Address: City: State: Zip Code: E-mail: Day Phone: () - Fax: () - *Method of Payment: I will be sending in a check for $60.00 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: 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 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: 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:
Specialty: Title: (M.D., D.O., etc)
Name (as you would like it on the certificate)
Address:
City: State: Zip Code:
E-mail:
Day Phone: () - Fax: () -
*Method of Payment: I will be sending in a check for $60.00 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:
1) 2)
3) 4)
5) 6)
7) 8)
9) 10)
Program Evaluation Summary
Not at all
Somewhat
Very Much
Please take another moment to answer the questions below. It will assist in identifying future topics for CME offerings.
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