1. What are your 2nd Dose Immunization Rates for:
Enter the % for at least one of the measures below (a, b, c and/or d).

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a. 2nd Dose COVID-19 %

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b. 2nd Dose Meningococcal ACWY % (e.g. Menactra%)

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c. 2nd Dose Meningococcal B % (e.g. Trumenba/Bexsero %)

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d. 2nd Dose HPV (e.g. Gardasil /Gardasil 9%)

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e. 2nd Dose Adult Hepatitis B % (Heplisav-B only)

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2. Were your rates higher, lower or exactly what you expected? (Required.)

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3. Do you plan on implementing change in your practice in the next 12 months to improve these rates?  (Required.)

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If yes, describe the strategy you plan to implement…

To process the CPP educational grant of $500, please provide the following information:

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Practice Name (Required.)

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Practice Address (Required.)

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Contact Name (Required.)

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Contact Email Address (Required.)

*Please note:  CPP will only use your contact information to issue the educational grant check.  CPP will not collect any patient specific information.  All immunization rates will be analyzed and reported as general trend data and will not be attributed to an individual practice.

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