Dentaltown September 2016 - 111

continuing education feature CONTINUING EDUCATION ANSWER SHEET Instructions: To receive credit, complete the answer sheet and mail it, along with a check or credit card payment of $36, to: Dentaltown.com, Inc., 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044. You may also fax this form to (480) 598-3450 or answer the post-test questions online at dentaltown.com/onlinece. This written self-instructional program is designated for 1.5 hours of CE credit by Farran Media. You will need a minimum score of 70 percent to receive your credits. Participants pay only if they wish to receive CE credits; thus no refunds are available. Please print clearly. This course is available to be taken for credit Sept. 1, 2016 through its expiration on Sept. 1, 2019. Your certificate will be emailed to you within 3-4 weeks. Laser Mucocele Removal in Pediatric Patients CE Post-Test 1. a b c d 2. a b c d 3. a b c d 4. a b c d Name ______________________________________________________________________________________________________ 5. a b c d Address ___________________________________________________________________________________________________ 6. a b c d 7. a b c d 8. a b c d 9. a b c d 10. a b c d by Drs. Robert Levine and Peter Vitruk License Number ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ AGD# _____________________________________________________________________________________________________ City ____________________________________________________ State ___________ ZIP ________________________ Daytime phone _____________________________________________________________________________________________ Email (required for certificate) ______________________________________________________________________________ o Check (payable to Dentaltown.com, Inc.) Please circle your answers. o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.) Card Number ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ Expiration Date - Month / Year ______ ______ / ______ ______ ______ ______ Signature ___________________________________________________________________________ Date __________________________________________________ Program Evaluation (required) Please evaluate this program by circling the corresponding numbers: (5 = Strongly Agree to 1 = Strongly Disagree) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Course administration was efficient and friendly Course objectives were consistent with the course as advertised COURSE OBJECTIVE #1 was adequately addressed and achieved COURSE OBJECTIVE #2 was adequately addressed and achieved COURSE OBJECTIVE #3 was adequately addressed and achieved COURSE OBJECTIVE #4 was adequately addressed and achieved COURSE OBJECTIVE #5 was adequately addressed and achieved Course material was up-to-date, well-organized, and presented in sufficient depth Instructor demonstrated a comprehensive knowledge of the subject Instructor appeared to be interested and enthusiastic about the subject Audio-visual materials use d were relevant and of high quality Handout materials enhanced course content Overall, I would rate this course (5 = Excellent to 1 = Poor): Overall, I would rate this instructor (5 = Excellent to 1 = Poor): Overall, this course met my expectations Comments (positive or negative): 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 _________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________ For questions, contact Director of Continuing Education Howard Goldstein at hogo@dentaltown.com. dentaltown.com \\ SEPTEMBER 2016 111 http://www.Dentaltown.com http://www.dentaltown.com/onlinece http://www.Dentaltown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown September 2016