Dentaltown January 2017 - 103

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, 9633 S. 48th St., Suite 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 Jan. 1, 2017, through its
expiration on Nov. 1, 2019. Your certificate will be emailed to you within 3-4 weeks.

Honing Our Edge

CE Post-Test
1.	a	 b	 c	 d

by Karen Siebert, BSDH, MA
License Number ______

______

______

______

______

______

______

______

______

______

AGD# _____________________________________________________________________________________________________

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

City ____________________________________________________

7.	a	 b	 c	 d

State ___________

ZIP ________________________

Daytime phone _____________________________________________________________________________________________
Email (required for certificate) ______________________________________________________________________________

8.	a	 b	 c	 d
9.	a	 b	 c	 d
10.	a	 b	 c	 d

o Check (payable to Dentaltown.com, Inc.)
o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.)

Please circle your answers.

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 used 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 \\ JANUARY 2017

103
http://www.dentaltown.com/onlinece http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown January 2017
