Assessment and Feedback Evaluation Instruments

Pre-visit Survey

Use this survey to evaluate providers beliefs and practices about HPV vaccination before your quality improvement (QI) consultation.

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Post-visit Survey

Use this survey to measure providers beliefs and practices about HPV vaccination right after your QI consultation and compare the results with the Pre-visit Survey. You can also use this survey to evaluate your CME activity if you certified your session for CME credits.

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Six-month Follow-up Survey

Use this survey to see how your QI efforts impacted providers' beliefs and practices over time.

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Data Collection Spreadsheet

Use this to record clinics' immunization rates throughout the length of your QI efforts.

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Clinic Tracking Spreadsheet

Use this spreadsheet to record which clinics are participating in your QI efforts, when you contacted them, and when you need to take the next step.

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Webinar Fidelity Checklist

An outside observer can use this checklist to evaluate how well a webinar consultation covered the important topics in an Assessment and Feedback consultation.

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