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Needs Assessment
Name of Site
Address/City/State
Contact Person/Position
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1. Are you or your staff familiar with satellite training courses for health professionals? 
YesNo

2a. Have you or your staff ever taken a satellite training course?
Yes No 
2b. If yes, what were the course topics?
3.How did this type of training benefit the targeted staff?

4. If regular satellite courses were offered, how often would you or your staff access them? 
Two or more times a monthOnce a monthOnce every two months
Once per quarterTwice a year
5. Which staff members would you like to target with the satellite trainings?
Physicians(specify specialties of interest, e.g., Ophthalmology)
Nurses
Health Educators
Administrators
Midwives
Other (please specify) 

6. Which subjects would be of greatest benefit to your staff?
Chronic Disease (such as HIV or cardiovascular disease; please specify) 
Bioterrorism
Dentistry 
Women’s health
Pediatrics
Senior health
Neurology
Preventive medicine
Surgery (please specify) 
Drug and alcohol treatment
Other 

7. Which aspect of care would be most beneficial to your staff?
Treatment Prevention Followup care
8. Would you prefer receiving ongoing training education via:
Satellite Online/Internet Mail Conferences
9. Other comments or suggestions: