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* 1. School Name

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* 2. School Address

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* 3. Phone Number

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* 4. Nurse or School Administrators Name

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* 5. Date of Service

Date

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* 6. Overall, how would you rate the OHIP program?

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* 7. How organized was the program?

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* 8. How likely is it that you would recommend OHIP to a friend or colleague?

Not at all likely
Extremely likely

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* 9. What suggestions do you have for improving this program?

T