Geriatric Needs Assessment Questionnaire

To help us better understand your geriatric continuing education needs, please take the time to complete this geriatric needs assessment questionnaire. The information collected will be used by the Miami Area Geriatric Education Center (MAGEC) for research, program design, and reporting purposes. Please complete and print and fax this form to (305) 355-9195.

Gender:

Cultural/Ethnic Background:

Other (please specify)

Health Profession Discipline:

Other (please specify)


Generally speaking, do you feel your knowledge about geriatrics is:

Which method(s) of training would you rate as most effective to achieve your learning goals? (Select up to 3)

Other (please specify)

Where would you most prefer to have training programs presented?

Other (please specify)

Please select the most convenient day(s) for you to attend training programs (select up to 3):

When would you prefer to have 2-3 day training programs held?

Other (please specify)

Which factor(s) most frequently prevent you from attending a training event (Select up to 3)?

Other (please specify)

Please select the geriatric education and training topic(s) you are most interest in (Select up to 6):

Other (please specify)

Would you be willing to attend training(s) on your chosen topic(s)?

What is the best way to reach you, in advance, about our training events (select up to 2)?

Other (please specify)

How much would you or your employer be willing to pay for a 10-20 credit hours geriatric education event?

Have you ever attended a MAGEC-sponsored event in the past?

Thank you for your valuable input. If you have any concerns or questions about this survey, please contact MAGEC via email: magec@med.miami.edu or phone: (305) 355-9123. When you are finished responding to all the questions, please click on the "Submit" button below to send it electronically. Or, you can print this questionnaire and fax it to: (305) 355-9195.

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