Your feedback is very important to us. Please complete this short survey to help us improve our program and better serve you. It will  only a few  minutes. Thank you very much.

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* 1. Does your clinic have a standing order and written procedures for Fluoride Varnish?

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* 2. When does your  Provider/s prescribe Fluoride Varnish?

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* 3. The office manager encourages Fluoride Varnish application.

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* 4. How many CHDP back office staff are trained to do Fluoride Varnish application?

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* 5. It is easy to complete the Fluoride Varnish log including client information in the clinic setting.

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* 6. Is the monthly Fluoride varnish log e mail reminder helpful?

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* 7. How satisfied are you with how timely Fluoride Varnish and other incentives are delivered?

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* 8. How satisfied are you with the Fluoride varnish application certification training?

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* 9. Do you find  the program's yearly recognition of Provider, Clinic and Staff valuable ( usually happens during February Children's Dental Health Month)?

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* 10. Is the current Fluoride Varnish color helpful?

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* 11. Please suggest possible incentive materials other than those  we currently provide.

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