Brush, Book, Bed Collaborative Final Survey

Brush, Book, Bed Collaborative Participant Final Survey

Participant Information

Expect this survey to take approximately 15 minutes to complete. The information you provide will be used to improve future Ohio AAP programs. You may denote "N/A" if you do not have an answer for any question, and use estimates or your best knowledge if needed. An * indicates a required field.

Please rate the frequency with which your practice currently addresses the following at WCVs with families birth - 5 years of age. (Select a number from the scale below.)

0 = Does not apply / do not wish to answer; 1 = Never; 2 = Rarely (at least once a month); 3 = Sometimes (at least once a week); 4 = Most of the time (almost every well visit)

Please rate your degree of confidence in your ability to do the following items. Select a number from the scale below.

0 = Does not apply/Do not wish to answer; 1 = Not at all confident; 2 = Somewhat Confident; 3 = Moderately Confident; 4 = Confident; 5 = Very Confident