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Please use the adjacent form to share with us some of the details
of the incentive program you designed. If you have pics of the incentive prizes, or a gift closet, or staff you wish to spotlight, please attach them to an e-mail to:
chiggin2@jhmi.edu

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We’ll be in touch to talk about showcasing your program!

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Testimonial Worksheet

Population (e.g. individual, group, special division, clinic-wide):

Incentive (e.g. gift cards, small prizes, vouchers):

Frequency of reinforcer (every day, 1x a week, 1x a month):

Cost of incentives:

Source of funding:

Change agent (name of person who spearheaded the implementation):

What is your name and title?

Telephone number:

When is the best time to reach you by phone?

Please use the text box below to discuss the following: Describe staff reaction. Describe reaction of patients, clients, staff as recipients.To tell us a lesson learned. Tell us about future plans:

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