Orthotown December 2020 - 48

continuing education

CONTINUING
EDUCATION
ANSWER
SHEET

Instructions: To receive credit, complete the answer sheet and mail it, along with a check or credit card
payment of $36, to: Orthotown.com, Inc., 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044. You may also fax this
form to (480) 598-3450 or answer the post-test questions online at orthotown.com/onlinece. This written
self-instructional program is designated for 1.5 hours of CE credit by Farran Media. You will need a minimum
score of 70 percent to receive your credits. Participants pay only if they wish to receive CE credits; thus
no refunds are available. Please print clearly. This course is available to be taken for credit Dec. 1, 2020,
through its expiration on Dec. 1, 2023. Your certificate will be emailed to you within 3-4 weeks.

Slop-py Work

1.	A	 B	 C	 D

by Drs. Elizabeth R. Michalczyk, Noam Green and Alise Senderak

2.	A	 B	 C	 D

License Number ______

______

______

______

CE Post-Test

______

______

______

______

______

______

AGD# _____________________________________________________________________________________________________
Name ______________________________________________________________________________________________________
Address ___________________________________________________________________________________________________
City ____________________________________________________

State ___________

ZIP ________________________

Daytime phone _____________________________________________________________________________________________
Email (required for certificate) ______________________________________________________________________________

3.	A	 B	 C	 D
4.	A	 B	 C	 D
5.	A	 B	 C	 D
6.	A	 B	 C	 D
7.	A	 B	
8.	A	 B	
9.	A	 B	 C	 D
10.	A	 B	 C	 D
Please circle your answers.

o Check (payable to Orthotown)
o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.)
Card Number ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______
Expiration Date - Month / Year ______ ______ / ______ ______ ______ ______
Signature ___________________________________________________________________________	

Date __________________________________________________	

Program Evaluation (required)
Please evaluate this program by circling the corresponding numbers: (5 = Strongly Agree to 1 = Strongly Disagree)
1.	 Course administration was efficient and friendly					
2.	 Course objectives were consistent with the course as advertised			
3.	 COURSE OBJECTIVE #1 was adequately addressed and achieved			
4.	 COURSE OBJECTIVE #2 was adequately addressed and achieved			
5.	 COURSE OBJECTIVE #3 was adequately addressed and achieved			
6.	 COURSE OBJECTIVE #4 was adequately addressed and achieved			
7.	 COURSE OBJECTIVE #5 was adequately addressed and achieved			
8.	 COURSE OBJECTIVE #6 was adequately addressed and achieved			
9.	 Course material was up-to-date, well-organized, and presented in sufficient depth		
10.	 Instructor demonstrated a comprehensive knowledge of the subject			
11.	 Instructor appeared to be interested and enthusiastic about the subject			
12. 	 Audio-visual materials used were relevant and of high quality				
13. 	 Handout materials enhanced course content					
14. 	 Overall, I would rate this course (5 = Excellent to 1 = Poor):				
15. 	 Overall, I would rate this instructor (5 = Excellent to 1 = Poor):				
16. 	 Overall, this course met my expectations					
Comments (positive or negative):

5	
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4	
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3	
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2	
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1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

_________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________
For questions, contact Director of Continuing Education Howard Goldstein at hogo@dentaltown.com.

48

DECEMBER 2020 // orthotown.com

OT1220_Michalczyk_CE-Bracket-Slop.indd 48

11/24/20 10:00 AM
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Orthotown December 2020

Table of Contents for the Digital Edition of Orthotown December 2020
