DTaP Drop-Off Post-Survey Name * First and Last Name Credentials Practice/Organization * Email Address * Phone Number * Address * Address 2 City * State * ------ Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Specialty * Primary Care Medical Subspecialty Surgeon Hospitalist Urgent Care OtherOther Please indicate the specific strategies you have implemented around increasing the rate of the fourth dose of the DTaP vaccination since taking part in the webinar. Please indicate which of the resources sent to you after the webinar you have used in your practice. (Check all the apply) DTaP Drop-Off Booklet Easy-to-Read Immunization Schedule DTaP Parent Handout DTaP Reminder Postcards OtherOther Please provide feedback on those resources. Would your practice be interested in joining a Quality Improvement program with the Ohio Chapter, American Academy of Pediatrics and potential receive MOC Part IV credit in the future? Yes No Maybe, I want more information If you are human, leave this field blank.