Preceptorship 30-Day Survey for Aesthetics

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Email(Required)

What is your specialty?(Required)

Please specify your specialty(Required)

Degree(Required)

Please specify your degree(Required)

Type of Practice(Required)

Please specify your type of practice(Required)

Number of years in practice

Self-Assessment

How has the preceptorship training session impacted your practice ability relative to the following skills/knowledge?(Required)

	Major improvement	Some improvement	No difference	My ability declined
Clinical assessment of patients and injection target selection
Injection technique
Guidance and localization of injections
Evaluation of patient outcomes
Facilitate interaction and improve communication among members of the interdisciplinary treatment team
Communicate with treatment team/patient

As a result of participating in this preceptorship, did you make changes to your practice in the following categories:(Required)

	Yes, within 7 days	Yes, within 14 days	Yes, within 21 days	Yes, within 30 days	No, not yet
Patient evaluation
Dosing and administration of botulinum neurotoxins
Assessing/evaluating patient outcomes
Documentation
Patient education
Other

If you answered other, please specify:

I have implemented the following specific change in my practice:

Please describe one clinical outcome in a specific patient case that you achieved or improved based on the skills and knowledge you developed in the preceptorship (please include HIPAA-/patient confidentiality–compliant patient descriptions):

Self-Assessment

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