Qualtrics Survey | Qualtrics Experience Management

First Name

Middle Name

Last Name

Email

California Dental License number (if applicable)

Do you practice in San Francisco?

Please provide your address (campus, business, or home)

First line

Second line (Optional)

City

State

Zip Code

What best describes your dental practice settings (check all that apply)

Do you currently accept patients with disabilities in your practice with Medi-Cal Dental coverage for office-based care?

How much do you agree with the following statements about session 5:

How much do you agree with the following statements about session 5:
	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The session was overall well organized.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Learning from a self-advocate's experience benefited me and the efforts of my practice.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The duration of the session adequately addressed my needs.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Overall, the course met my continuing dental education needs.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The platform was easy to use.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The session increased my knowledge about dental care for persons with Special Health Care Needs.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The session increased my confidence in providing dental care for persons with Special Health Care Needs.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Because of this session, I will likely see more patients with Special Health Care Needs in my practice.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I plan to make changes to my practice based on what I learned in this session.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

How much do you agree with the statement about session 7 meeting the following learning objectives:

How much do you agree with the statement about session 7 meeting the following learning objectives:
	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
To understand dental care coordination in SF Bay area for people with special health care needs.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
To learn about the barriers to effectively implement care coordination for this vulnerable population.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
To learn about the existing lists of dental providers used by Child Health and Disability Prevention Program (CHDP).	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
To learn about the dental care coordination system used by the Alameda County Public Health Department, Office of Dental Health.	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

How much do you agree with the following speakers/Moderator being effective and well-organized:

How could we make the program better?

What topics would you like addressed to help you understand and treat people with Special Health Care Needs?

What barriers remain for you that could prevent you from seeing patients with Special Health Care Needs?