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* 1. First Name

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* 2. Last Name

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* 3. Email Address

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* 4. Practice Name

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* 5. Practice Address

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* 6. What is your credential?

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* 7. What is your specialty?

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* 8. Which of the following is the best description of your practice?

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* 9. Have you participated in an Ohio AAP Childhood Lead Prevention Training or QI Project?

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* 10. How did you learn about the toolkit? (Select all that apply)

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* 11. How confident are you in providing lead anticipatory guidance and resources?

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* 12. What are your top 1-2 reasons for requesting the Lead toolkit?

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