Evaluation -

Early Childhood Oral Health in the General Dentistry Office 2nd Edition

Providing dentists with the opportunity for continuing dental education is an essential part of MetLife’s commitment to helping dentists improve the oral health

of their patients through education.

You can help in this

effort by providing feedback regarding the continuing education offering you have just completed.

FOR

OFFICE

USE

ONLY

Registration/Certification Information

(Necessary for proper certification)

Name (Last, First, Middle Initial): __________________________________________________________________

Street Address: _____________________________________________________

Suite/Apt. Number _________

City: ______________________________________ State: _______________ Zip: _____________________

Telephone: _______________________________________

Fax: ______________________________________

Date of Birth: ______________________________________

Email: ____________________________________

State(s) of Licensure: _______________________________

License Number(s): __________________________

Preferred Dentist Program ID Number: _____________________________

Check Box If Not A PDP Member

AGD Mastership:

Yes

No

AGD Fellowship:

Yes

No

Date: ______________

Please Check One:

General Practitioner

Specialist

Dental Hygienist

Other

PLEASE PRINT CLEARLY

Please respond to the statements below by checking the appropriate box,

1 = POOR

5 = Excellent

using

the scale on the right.

1

2

3

4

5

1.

How well did this course meet its stated educational objectives?

2.

How would you rate the quality of the content?

3.

Please rate the effectiveness of the author.

4.

Please rate the written materials and visual aids used.

5.

The use of evidence-based dentistry on the topic when applicable.

N/A

6.

How relevant was the course material to your practice?

7.

The extent to which the course enhanced your current knowledge or skill?

8.

The level to which your personal objectives were satisfied.

9.

Please rate the administrative arrangements for this course.

10.

How likely are you to recommend MetLife’s CE program to a friend or colleague?

(please circle one number below:)

10

9

8

7

6

5

4

3

2

1

0

e

xtremely likely

neutral

not likely at all

What is the primary reason for your 0-10 recommendation rating above?

11.

Please identify future topics that you would like to see:

Thank you for your time and feedback.

To complete the program traditionally, please mail your post test and registration/evaluation form to:

MetLife Dental Quality Initiatives Program

l

501 US Highway 22

l

Bridgewater, NJ 08807