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Contact EURACT
E-mail
Phone
(32) 16 33 74 64
FAX
(32) 16 33 74 80
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After the successful completion of an exchange visit this evaluation form
has to be completed. The evaluations will be the basis for an annual report to the WONCA/EURACT-council on the progress of the programme as well as documentation for the later application for EU-funding.
EVALUATION FORM - HOST PRACTICE
| Practice: |
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Trainee: |
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| Address: |
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Address: |
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| Name of Practice Partner filling out the
form: |
| Dates for Exchange Study Visit: |
| Were there any difficulties in the preparation
of the Exchange Study Visit? |
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| What was the output for the practice from
the Exchange Study visit? |
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| What was especially good/successful? |
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| What could have been better? |
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EVALUATION FORM - HOST PRACTICE
| Practice: |
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| Do you find the participation of your practice in the "Hippokrates"-programme
as being important/worthwhile, and if so, why? |
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| On a scale from 0(worst) to 10(best) how do you rate this Exchange
Study Visit as a whole? |
| Rating: |
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| Do you plan to promote the "Hippokrates"-programme
among your colleagues, and if so, how? |
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| Further comments, suggestions (if necessary please continue overleaf) |
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Please send to:
WONCA Region Europe, EURACT Secretariat
General Practice Dept., Catholic University of Leuven
Kapucijnenvoer 33, Blok J, B-3000 Leuven, Belgium
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