Oral Complications of Medication Usage Course 1 (2 units): $22 CE Article Begins on Page 30 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Comprehensive Approach To Early Childhood Caries Course 2 (2 units): $22 CE Article Begins on Page 34 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Enhance Healing Using Leukocyte Platelet Rich Fibrin Course 3 (2 units): $22 CE Article Begins on Page 40 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Tobacco Intervention Strategies Course 4 (2 units): $22 CE Article Begins on Page 44 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. SECTION 1 Name: License Number: Address: City: Phone: Email: State: Check: Answer Sheet • December 2017 The following CE courses will expire on December 31, 2020 Title: License Renewal Month: Zip: Home Fax: (RECOMMENDED FOR ACCESS TO YOUR ACCOUNT WHEN USING OUR ONLINE CE LIBRARY.) AGD Membership Number (IF AGD FELLOWSHIP, MASTERSHIP OR MEMBERSHIP MAINTENANCE CREDIT IS REQUIRED): Three Ways to Receive CE Credit for Th ese Courses 1. Online: Submit your answers online by visiting DecisionsInDentistry.com.* Submitting online allows instant access to verification of participation and easy recordkeeping. 2. Mail: Answer sheets can be mailed with credit card information or a check. CE courses paid by check require three days for processing after receipt. Mail to: Belmont Publications, Inc., 3621 Harbor Blvd., Suite 265, Santa Ana, CA 92704.* 3. Fax: Answer sheets can be faxed with credit card information to Belmont Publications, Inc.; Fax: 714-825-1230.* *Users who successfully submit an online answer sheet do not need to mail or fax this form. There is only one answer per question. SECTION 2 Visit DecisionsInDentistry.com to take the test online for immediate results! Payment Method: Payment of $22 is enclosed for one course, $44 for two courses, $66 for three courses, or $88 for all four courses (checks require three days for processing after receipt). Please make checks payable to Belmont Publications, Inc. Charge my credit card $22 for one course, $44 for two courses, $66 for three courses, or $88 for all four courses (Charges will appear on statement as Belmont Publications, Inc.) Cardholder’s Name (as printed on card): Cardholder’s Billing Address: City: Card #: State: Amex Visa Zip: Expiration Date: Card Verification Number (3- or 4-digit number on back of card, or front of card on Amex): ________________________________ Signature: Send verification of participation for this course via (please provide contact information in Section 1): SECTION 3 Mail Course Evaluation Please take a few moments to evaluate this course by responding to the following statements using a scale of: Excellent = 5 to Poor = 1 Course 1: Course 2: Were the objectives and educational methods appropriate? 54 3 Were the course objectives accomplished? 54 3 2 Please rate the course content. 54 3 Was the overall administration of the course effective? 54 3 How do you rate the authors’ grasp of the topic? Do you feel that the references were adequate? 54 3 Would you take a CE course similar to this one in the future? Was there any subject matter about which you were unclear? Yes Yes No If yes, explain: Please estimate time spent to complete this course: No 2 Were your personal educational objectives met? 54 3 2 54 3 2 1 1 1 Would you take a CE course similar to this one in the future? Was there any subject matter about which you were unclear? Yes Yes No If yes, explain: Please estimate time spent to complete this course: What additional continuing education topics would you like to see? __________________________________________________________________________________________________________________________________________ IF CHECK ENCLOSED, PLEASE SEAL ALL OPEN EDGES No 2 1 Please rate the instructors’ effectiveness. 54 3 2 2 2 1 1 1 1 Were the objectives and educational methods appropriate? 54 3 Were the course objectives accomplished? 54 3 Please rate the instructors’ effectiveness. 54 3 2 Please rate the course content. 54 3 2 2 Was the overall administration of the course effective? 54 3 How do you rate the authors’ grasp of the topic? Do you feel that the references were adequate? 54 3 2 Were your personal educational objectives met? 54 3 2 54 3 2 1 1 1 2 1 2 1 1 1 1 Course 3: Were the objectives and educational methods appropriate? 54 3 Were the course objectives accomplished? 54 3 Please rate the instructors’ effectiveness. 54 3 2 Please rate the course content. 54 3 2 2 Was the overall administration of the course effective? 54 3 How do you rate the authors’ grasp of the topic? Do you feel that the references were adequate? 54 3 Would you take a CE course similar to this one in the future? Was there any subject matter about which you were unclear? Yes Yes No If yes, explain: Please estimate time spent to complete this course: No 2 Were your personal educational objectives met? 54 3 2 54 3 2 1 1 1 2 1 2 1 1 1 1 Course 4: Were the objectives and educational methods appropriate? 54 3 Were the course objectives accomplished? 54 3 Please rate the instructors’ effectiveness. 54 3 2 Please rate the course content. 54 3 2 2 Was the overall administration of the course effective? 54 3 How do you rate the authors’ grasp of the topic? Do you feel that the references were adequate? 54 3 Would you take a CE course similar to this one in the future? Was there any subject matter about which you were unclear? Yes Yes No If yes, explain: Please estimate time spent to complete this course: No 2 Were your personal educational objectives met? 54 3 2 54 3 2 1 1 1 2 1 2 1 1 1 1 Email Suggestion Box We would love to hear your thoughts on Decisions CE. Please take the time to fill out the course evaluation below. You can also email your feedback to: [email protected]. MasterCard Discover Office Decisions in Dentistry
