HPV Survey – TIES Practices HPV TIES Survey 2016 Demographics Number of physicians, nurses and medical assistants at this practice: Number of physicians, nurses and medical assistants using TIES information: Percent of patient population that is on Medicaid: Average number of patients seen every week (unduplicated): Practice location: Rural Urban Suburban Survey How likely are parents to agree to vaccinate their teen against HPV? 1 - Extremely Unlikely 2 - Unlikely 3 - Neutral 4 - Likely 5 - Extremely Likely Comment: What are parents’ stated reasons for refusing the HPV vaccine? Lack of knowledge about the vaccine Concerns over safety Concerns over impact on sexual behavior Belief the vaccine is not necessary OtherOther How likely are patients to complete all three HPV shots? 1 - Extremely Unlikely 2 - Unlikely 3 - Neutral 4 - Likely 5 - Extremely Likely Comment: How confident are you recommending the HPV vaccine? 1 - Extremely Not Confident 2 - Not Confident 3 - Neutral 4 - Confident 5 - Extremely Confident How confident are you answering questions about the HPV vaccine? 1 - Extremely Not Confident 2 - Not Confident 3 - Neutral 4 - Confident 5 - Extremely Confident What are the biggest barriers in your practice/department operations for HPV vaccination? Lack of provider recommendation Financial Parents OtherOther How has TIES helped address those concerns? What additional assistance does your practice need regarding the HPV vaccine? If you would like some FREE HPV Reminder magnets, please enter mailing information below! If you are human, leave this field blank.