Download and Share Screen Time-Out Infographics Give Us Your Feedback Contact Us What is your professional affiliation? (Please check all that apply) Nurse Community Health Worker Health Educator Diabetes educator Occupational therapist Occupational therapist assistant Social worker Student Other If you selected "Other," please describe: When were you trained (approximate date)? MM slash DD slash YYYY What state are you from? AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Approximately how many people have you served to date with the knowledge and skills you gained from this training? (“Served” may include providing information about vision and eye health, conducting a vision risk assessment and/or a vision screening.)01-5051-100101-200201-500500+not sureApproximately how many people do you estimate you will serve over the next 12 months with the knowledge and skills you gained from this training? (“Served” may include providing information about vision and eye health, conducting a vision risk assessment and/or a vision screening.)01-5051-100101-200201-500500+not sureWhat are the general characteristics of those persons you have served with your Healthy Eyes knowledge and skills? (Mark all that apply) Adults (age 18-65) Senior adults (age 65+) Individuals with chronic diseases (such as diabetes, COPD, arthritis, etc.) General public African-American/Black individuals Hispanic/Latinx individuals Asian/Pacific Islander individuals Caucasian individuals Native American individuals Uninsured/underinsured individuals Please list 2-3 pieces of information or new skills you learned in the training that you are now using in your work.What other vision and eye health information or resources would be helpful to you in the future?Do you have a client success story based on the information you learned from this training you would like to share with us?Are there any other thoughts you would like to share regarding your experience with the training?Would you like to subscribe to your Prevent Blindness affiliate e-newsletter?YesNoIf you answered yes to the previous question, please provide your email address to receive the e-newsletter.. CAPTCHANameThis field is for validation purposes and should be left unchanged.