Week by week
Survey for nurses
Participating Nurse:_________________________Date__________________
City: ___________________________ and State: __________
Week 1 2 3 4
1 - Ease of use for both the resident and caregiver?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
2– Is The Answer® easier to measure and administer than toothpaste?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
3 – Noticeable improvement of plaque, gum, sores and lesions?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
4 – Does the treatment protocol takes less than five minutes per patient to complete?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
5 – The Answer® does not require extensive clean-up?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
* Must be Administered - After the Evening Medications, Food and/or Drink.
The Cloonan Corporation 1440 Grand Avenue, Suite D, San Marcos, CA 92078
Phone (760) 891-0078 www.theanswer2oralcare.com
Survey for nurses
Participating Nurse:_________________________Date__________________
City: ___________________________ and State: __________
Week 1 2 3 4
1 - Ease of use for both the resident and caregiver?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
2– Is The Answer® easier to measure and administer than toothpaste?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
3 – Noticeable improvement of plaque, gum, sores and lesions?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
4 – Does the treatment protocol takes less than five minutes per patient to complete?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
5 – The Answer® does not require extensive clean-up?
A =Strongly Disagree A A A A
B = Disagree B B B B
C = Neutral C C C C
D = Agree D D D D
E = Strongly agree E E E E
* Must be Administered - After the Evening Medications, Food and/or Drink.
The Cloonan Corporation 1440 Grand Avenue, Suite D, San Marcos, CA 92078
Phone (760) 891-0078 www.theanswer2oralcare.com
