Water Smart Broward Prescription Program Survey

Pediatricians

Question Title

1. Do you feel the Water Smart Broward handbook is a helpful resource?

Excellent

Very Good

Good

Fair

Poor

Question Title

2. Do you feel the Water Smart Broward Prescription Program is an effective program?

Excellent

Very Good

Good

Fair

Poor

Question Title

3. Did you discuss water safety with your patients prior to the Water Smart Prescription Program?

Already Enrolled

Definitely

Likely

Uncertain

Not Likely

Question Title

4. Are you likely to continue to participate in the Water Smart Prescription Program?

Already Enrolled

Definitely

Likely

Uncertain

Not Likely

Question Title

5. What is the ZIP code of your office/practice?

Question Title

6. Additional thoughts and comments: