DENTAL TRAINING: FLUORIDE VARNISH

Evaluation Form

Date of Training: * +

I am a: *

1. After participating in this training, I feel I am better informed about the risk factors for decay and the importance of preventive dental care. *

2. After this training, I am more confident in my ability to apply fluoride varnish. *

3. After this training, our clinic will start providing fluoride varnish applications to children under 6 who are at risk for dental caries? *

Yes!

No. Please state why: No. Please state why:

4. The format and timing of training, Q & A, and practicum were appropriate and helpful. *

5. Overall, the training was: *

6. I would like a practice kit of fluoride varnish materials sent to my clinic so that I may practice applying fluoride varnish on myself, a model or a coworker. *

Yes

No, thank you

Describe at least one thing you learned from the training that will be helpful to you at your clinic: *

Additional comments:

Your training certificate will be emailed to you upon completing the training evaluation form. Please complete contact information. Thank you!

Attendee name: *

Clinic/Office: *

Address: *

County: *

City: *

Zip Code: *

Email: *

Phone number: *