COPE Post-Activity Evaluation Form CE credits will be submitted within 30 days of submission. Please complete the ARBO required survey below to secure your credits. COPE Post-Activity Educational Evaluation Please complete this form to secure COPE Credits. Doctor's Name(Required) First Last Email Address(Required) OE Tracker Number(Required) License Information(Required) License Number AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Event Name(Required)Please select from the options in the dropdown below.Chocolate Tasting EventRed Shoes EventAnnual Educational RetreatThink Pink EventWinter Wonderland EventEvent/Chapter Location(Required)Please enter the event city and state below. City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State As a result of this CE activity, I have developed new strategies to address the issues that were discussed.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, my ability and skills have been improved.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, I have identified changes I will implement in my practice.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, I will significantly change the way I will treat and care for my patients.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree As a result of this CE activity, I expect positive changes in my patient outcomes.(Required) Strongly Agree Agree Somewhat Agree Neither Agree nor Disagree Somewhat Disagree Disagree Comments