Feedback Form

Please complete the following survey so that we may obtain your opinion, criticisms and suggestions for improvements with reference to the event you are currently.

Course Name:
Course Date:
Select a date from the calendar.
Candidate Name:
Hospital Address:
Email Address:  
Please state your position in the hospital:
Please state the number of years you have been in practice:
Please state the number of cases you perform by yourself per year:

How would you grade this event:

The Health Economic session was relevant & informative (if applicable):

There was enough time to interact with colleagues:

The content was educational enough to help me to improve my practice:

The presentation was engaging and comprehensive:

Overall, I was satisfied with this event:

Do you have any additional comments on quality of the whole event:
Faculty Speaker
Teaching skills:

Ability to teach a reproducible technique:

Ability to discuss how to avoid complications & answer all questions:

Honest on his own experience:

Ability to build a clinical program:

Know–how to easily approach the participants:

Ready to answer all questions and enter into discussion and debate with participants:

Please grade the following. The products I was trained on meets my needs:

I find a place/procedure where I can apply the products in my practice:

How would you rate the demo session (if applicable):

What values do you see this course is adding to your practice:
Do you believe you require further information before trying these techniques:

What type of additional information would you need:
Hotel Accommodation (if applicable):

Group Dinner (if applicable):

SSI Staff:

What is ONE KEY LEARNING you have taken away from this event:
SSI would like to further contact you, in regard to new professional education possibilities that we can offer you:
If you wish to be in the database, please add you e-mail address/s: