1. Arizona State Immunization Information System (ASIIS) 2011 Survey

Dear ASIIS user:

Please complete this survey by November 30th to be eligible for a $50 VISA Gift Certificate donated by The Arizona Partnership for Immunization (TAPI). Your answers will help us improve the program to serve you and Arizona's children better. The survey should take approximately 7 minutes to complete.

* 1. Should you have questions related to this survey or any other ASIIS issue, please contact our office at (602) 364-3899.

* 2. Type of Practice (Please check the box that best represents your practice/facility)

* 3. Title of person completing this form: