How likely are you to recommend this course/program to a friend or colleague? *

	1	2	3	4	5
(1 = Not at all likely, 5 = Extremely likely)	(1 = Not at all likely, 5 = Extremely likely) - 1	(1 = Not at all likely, 5 = Extremely likely) - 2	(1 = Not at all likely, 5 = Extremely likely) - 3	(1 = Not at all likely, 5 = Extremely likely) - 4	(1 = Not at all likely, 5 = Extremely likely) - 5

Please indicate your level of agreement on each of the following statements *

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The instructor(s) were effective.	The instructor(s) were effective. - Strongly Agree	The instructor(s) were effective. - Agree	The instructor(s) were effective. - Neutral	The instructor(s) were effective. - Disagree	The instructor(s) were effective. - Strongly Disagree
The content was relevant to my scope of practice.	The content was relevant to my scope of practice. - Strongly Agree	The content was relevant to my scope of practice. - Agree	The content was relevant to my scope of practice. - Neutral	The content was relevant to my scope of practice. - Disagree	The content was relevant to my scope of practice. - Strongly Disagree
This activity addressed my identified practice gaps within the subject area.	This activity addressed my identified practice gaps within the subject area. - Strongly Agree	This activity addressed my identified practice gaps within the subject area. - Agree	This activity addressed my identified practice gaps within the subject area. - Neutral	This activity addressed my identified practice gaps within the subject area. - Disagree	This activity addressed my identified practice gaps within the subject area. - Strongly Disagree
What is one specific action you plan to implement because of this activity?
	- What barriers may prevent you from applying what you learned? (Select all that apply) * Time constraints Lack of institutional/system resources Patient-related factors (e.g., acceptance, adherence, cultural factors) Not applicable — no barriers expected Other (specify)	- What barriers may prevent you from applying what you learned? (Select all that apply) Other (specify)	- Time constraints	- Lack of institutional/system resources	- Patient-related factors (e.g., acceptance, adherence, cultural factors)	- Not applicable — no barriers expected
What are the most significant social determinants of health affecting your patient population and the community you serve? (Consider factors such as food security, transportation, housing, economic stability, education, social support, and neighborhood safety.)
Please indicate your level of agreement on each of the following statements.	Please indicate your level of agreement on each of the following statements. - As a result of this activity, I am more aware of how social drivers of health, cultural factors, and implicit bias may affect patient care and outcomes. (1 = Strongly Disagree → 5 = Strongly Agree) * 1 2 3 4 5
Please provide any additional feedback about this program, faculty, educational format and/or FUTURE TOPICS you would like to see this team present:

Please indicate your level of agreement on each of the following statements *

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The instructor(s) were effective.	The instructor(s) were effective. - Strongly Agree	The instructor(s) were effective. - Agree	The instructor(s) were effective. - Neutral	The instructor(s) were effective. - Disagree	The instructor(s) were effective. - Strongly Disagree
The content was relevant to my scope of practice.	The content was relevant to my scope of practice. - Strongly Agree	The content was relevant to my scope of practice. - Agree	The content was relevant to my scope of practice. - Neutral	The content was relevant to my scope of practice. - Disagree	The content was relevant to my scope of practice. - Strongly Disagree
This activity addressed my identified practice gaps within the subject area.	This activity addressed my identified practice gaps within the subject area. - Strongly Agree	This activity addressed my identified practice gaps within the subject area. - Agree	This activity addressed my identified practice gaps within the subject area. - Neutral	This activity addressed my identified practice gaps within the subject area. - Disagree	This activity addressed my identified practice gaps within the subject area. - Strongly Disagree
What is one specific action you plan to implement because of this activity?
	- What barriers may prevent you from applying what you learned? (Select all that apply) * Time constraints Lack of institutional/system resources Patient-related factors (e.g., acceptance, adherence, cultural factors) Not applicable — no barriers expected Other (specify)	- What barriers may prevent you from applying what you learned? (Select all that apply) Other (specify)	- Time constraints	- Lack of institutional/system resources	- Patient-related factors (e.g., acceptance, adherence, cultural factors)	- Not applicable — no barriers expected
What are the most significant social determinants of health affecting your patient population and the community you serve? (Consider factors such as food security, transportation, housing, economic stability, education, social support, and neighborhood safety.)
Please indicate your level of agreement on each of the following statements.	Please indicate your level of agreement on each of the following statements. - As a result of this activity, I am more aware of how social drivers of health, cultural factors, and implicit bias may affect patient care and outcomes. (1 = Strongly Disagree → 5 = Strongly Agree) * 1 2 3 4 5
Please provide any additional feedback about this program, faculty, educational format and/or FUTURE TOPICS you would like to see this team present:

In your practice setting, how are assessments of social drivers of health utilized? (Select All) *

To inform discharge planning

To inform shared decision making and clinical care plans

For referrals to social services organizations

For population health analytics

To support equity initiatives

For quality management

Other (specify)

In your practice setting, how are assessments of social drivers of health utilized? (Select All) Other (specify)

During this course, did you feel you were influenced by any outside vendor or program sponsor? *

Yes

No

Please explain:

What is one key insight you are taking back to your practice? *

Leave this field blank