FAPD Zoom CE Attestation
Name
First Name
Last Name
Email
example@example.com
Dental License Number
DN
HAD
HYG
Other
License
State
Number
Date
-
Month
-
Day
Year
Date Picker Icon
Name of CE
Domestic Violence
Human Trafficking
Medical Errors
Medical Emergencies for Sedation
I attest that I have attended the above Zoom CE course.
*
by checking this box I understand and accept this statement.
Submit
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