Please complete the following quiz and evaluation questionnaire to receive
certificate of completion.
EVALUATION QUESTIONNAIRE

DISSOCIATION 101: THE BASICS EVALUATION

PRESENTER: ANSTASIA POLLOCK, LCMHC

CONTENT/FORMAT/LEARNING:

THE FOLLOWING LEARNING OBJECTIVES WERE ACHIEVED:

OVERALL RATING

TRAINING COMPLETION QUIZ

DISSOCIATION 101: THE BASICS COMPLETION

SALT LAKE COUNTY
7300 S. 300 W. Ste 101
Midvale, UT 84047
Phone: (801) 984-1717
Fax: (801) 984-1720
UTAH COUNTY
150 S. 400 E.
American Fork, UT 84003
Phone: (801) 980-7222
Fax: (801) 980-7223
© 2018 Life Stone Group, LLC All Rights Reserved. 
Insurance Billing Dept:
(801) 296-2113

Mailing Address:
7300 S. 300 W. Ste 101
Midvale, UT 84047