NUCCA 2021 Small Steps Participation Question Title * 1. Will you be participating in the 2021 Small Steps to Success Campaign within your office? Yes No Question Title * 2. If you are not participating in 2021, please explain why. Question Title * 3. How would you like to access your campaign resources (i.e. patient letter, poster) I will download from website I would like a packet mailed to me I am not participating Question Title * 4. Please indicate where you would like your packet mailed. Name Practice (leave blank if mailing to home) Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Done