Lead Toolkit Registration Form Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Email Address Question Title * 4. Practice Name Question Title * 5. Practice Address Street City Zip Code Question Title * 6. What is your credential? MD DO DNP NP PA Other (please specify) Question Title * 7. What is your specialty? General Pediatrics Family Medicine Other (please specify) Question Title * 8. Which of the following is the best description of your practice? Solo practice Group practice Hospital-owned Federally Qualified Health Center (FQHC) Academic Health Center Other (please specify) Question Title * 9. Have you participated in an Ohio AAP Childhood Lead Prevention Training or QI Project? Yes, I have participated in a training Yes, I have participated in the QI project No Other (please specify) Question Title * 10. How did you learn about the toolkit? (Select all that apply) Ohio AAP Today newsletter Personal email from Ohio AAP Personal phone call from Ohio AAP Other Ohio AAP email Ohio AAP Annual Meeting Ohio AAP live webinar/training Ohio AAP Facebook Ohio AAP Instagram Ohio AAP Twitter Ohio AAP LinkedIn Word of mouth (e.g., colleague, friend, patient/family) Other (please specify) Question Title * 11. How confident are you in providing lead anticipatory guidance and resources? Extremely confident Very confident Somewhat confident Not so confident Not at all confident Question Title * 12. What are your top 1-2 reasons for requesting the Lead toolkit? Done