Participating Nurse: ________________________Date__________________
Week 1 2 3 4
1 - Ease of use for both the resident and caregiver?
A =Strongly Disagree
B = Disagree
C = Neutral
D = Agree
E = Strongly agree
2– Is The Answer® easier to measure and administer than toothpaste?
A =Strongly Disagree
B = Disagree
C = Neutral
D = Agree
E = Strongly agree
3 – Noticeable improvement of plaque, gum, sores and lesions?
A =Strongly Disagree
B = Disagree
C = Neutral
D = Agree
E = Strongly agree
4 – Does the treatment protocol takes less than five minutes per patient to complete?
A =Strongly Disagree
B = Disagree
C = Neutral
D = Agree
E = Strongly agree
5 – The Answer® does not require extensive clean-up?
A =Strongly Disagree
B = Disagree
C = Neutral
D = Agree
E = Strongly agree
* Must be Administered - After the Evening Meds, Food and/or Drink.
®
| Is a Patented product |
| The Answer® Week by week Survey for nurses |
| The Cloonan Corporation |
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