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Online Liver Educational Program Evaluation Form

* Required Fields
WHAT PROGRAM DID YOU WATCH?*
Dr. Dieterich, "Hepatitis C" Dr. Gaglio, "Autoimmune Hepatitis"
Dr. Palmer, "Diet, Nutrition and Exercise"Dr. Basu, "NASH/Fatty Liver"
Dr. Bodenheimer, "PBC"Dr. Wolf, "Liver Cancer"
Dr. Jacobson, "Hepatitis B"
KNOWLEDGE BEFORE THE PROGRAM?
Before viewing this program, my knowledge on this topic was:*
ExcellentVery Good
GoodFair
Poor
KNOWLEDGE AFTER VIEWING?
As a result of this program, my knowledge is now:*
ExcellentVery Good
GoodFair
Poor
ABOUT YOU:
Age:*
Under 1818-29
30-4950-65
65+
Gender:*
MaleFemale
Ethnicity:
African AmericanAsian/Pacific Islander, please specify
Caucasian Latino, please specify
Other, please specify
Are you a (please check all that apply):
PatientMedical Professional
Social Service ProfessionalGeneral Audience
Family Member/CaregiverOther
How did you hear about this program?
FriendNewsletter
ALF Web siteDoctor/Health Care Clinician
Other
IF YOU WOULD LIKE TO RECEIVE MAILINGS, NEWSLETTERS AND OTHER INFORMATION FROM ALF, PLEASE ENTER YOUR EMAIL ADDRESS HERE:
THANK YOU!

Page updated: October 19th, 2008