Evaluation of this Program (Movement Disorders) Question Title * 1. Was the information presented in this activity biased and/or compromised by commercial support? Yes No If Yes, please explain. Question Title * 2. Did this activity meet its stated learning objectives? Check ALL that were met. Describe the clinical presentation and phenomenology associated with Parkinson’s Disease (PD) and other movement disorders. Discuss the diagnostic approaches and tools available for PD and other movement disorders. Identify and manage motor complications in PD such as moor fluctuations and dyskinesia. List the relevant treatment options for PD and other movement disorders. Evaluate surgical options and procedures available for PD and other movement disorders. Discuss Deep Brain Stimulation (DBS), indications, contraindications, risks and benefits. Evaluate the management of patients after DBS surgery. Identify movement disorders that can be treated with botulinum toxin injections. Describe the clinical presentation and phenomenology of tardive dyskinesia and other hyperkinetic movement disorders such as Huntington’s disease. Discuss the treatment options to mange tardive dyskinesia and other hyperkinetic movement disorders. Identify and manage non-motor features of PD. Question Title * 3. How do you rate Dr. Dashtipour’s delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 4. How do you rate Dr. Espay’s delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 5. How do you rate Dr. Tagliati’s delivery of this education? Excellent Very Good Average Needs Improvement Question Title * 6. Did this activity provide new information to you? Yes No Question Title * 7. Was the educational approach used in this activity conducive to your learning experience? Yes No Question Title * 8. Was the information presented applicable to your clinical practice? Yes No Question Title * 9. Will the information presented help you to improve your patients’ outcomes? Yes No Question Title * 10. This activity increased my knowledge, competence, and/or will improve my performance in my practice Yes No Question Title * 11. Of the patients you will see in the next week, about how many will benefit from the information you learned by participating in this activity? 1-10 11-25 26-50 >50 Question Title * 12. Based upon your participation in this activity, do you intend to change your practice behavior? Yes, I plan to implement changes in my practice based on the information presented No, I need more information before I will make any changes to my practice behavior Not applicable – My current practice has been reinforced by the information presented Question Title * 13. If you plan to change your practice behavior, what type of change(s) do you plan to implement? Check all that apply. Differentiate and diagnose movement disorders Treat and manage movement disorders Utilize surgical, deep brain stimulations, or injection options on a case-by-case basis Manage non-motor features of movement disorders Question Title * 14. Are there any barriers that would keep you from implementing the practice paradigms discussed in this activity? Lack of evidence-based guidelines Lack of applicability of guidelines to my current practice and/or patients Lack of time Organizational/Institutional Insurance/Financial Patient Adherence/Compliance Treatment related adverse events No perceived barriers Other (please specify) Question Title * 15. Please give us your overall comments regarding this activity. Question Title * 16. Claim Credit I certify that I have participated in the number of hours (0.25 increments, up to 6 hours chosen below) of this educational activity and request a CME certificate indicating that number of credits. I will claim only the total number of hours for which I participated. [Please print legibly.] Question Title * 17. Number hours you participated in this activity (0.25 increments, up to 6 hours). 6.0 5.75 5.5 5.25 5 4.75 4.5 4.25 4.0 3.75 3.5 3.25 3.0 2.75 2.5 2.25 2.0 1.75 1.5 1.25 1.0 0.75 0.5 0.25 Question Title * 18. Please Fill out the form below for your CME/CE Certificate First and Last Name Title (MD, DO, NP, PA, RN, etc.) Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 19. What is your specialty (Ex. Family Practice, Neurology, etc) Question Title * 20. How many years have you been in practice? < 10 10-20 21-30 > 30 Question Title * 21. How many days a week do you see patients? 0-1 2-3 4-5 6-7 Question Title * 22. How many patients do you typically see per day? 0-10 11-20 21-30 31-40 > 40 Question Title * 23. What is your practice like? Solo or small group (1-5 providers) Large group (> 5 providers) Government Owned Facility/Clinic Retired/Not Seeing Patients Other (please specify) Done