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First Name *

Last Name *

Email *

Username *

Password *

Confirm Password *

Please indicate your provider type *

Please indicate the state in which you currently practice *

Preferred Name

Please select the option that best reflects the geographic setting in which you primarily practice *

Please provide the zip code of the facility in which you primarily practice. If you practice in more than one facility, please enter the zip code of the facility where you spend the most time. *

Please select the option that reflects the clinical setting in which you primarily practice *

If "other", please specify

How many years have you been in practice? *

Does the facility where you primarily practice currently provide substance use disorder treatment services? *

We are interested in understanding what if any prior training you have received in caring for patients with substance use and/or substance use disorder. Please select all that apply.

Do you ever prescribe or order any of the following medications for opioid use disorder or alcohol use disorder? Please select all that apply. *

Please indicate your level of agreement with the following statement: Substance use and/or substance use disorder is a significant issue among the patients served by the facility where I work. *

Strongly Disagree

Somewhat Disagree

Somewhat Agree

Strongly Agree

Please indicate your level of agreement with the following statement: Substance use and/or substance use disorder is a significant issue among the patients I see. *

Strongly Disagree

Somewhat Disagree

Somewhat Agree

Strongly Agree

Reflecting on the last three months, how many patients did you see who had a need for substance use or substance use disorder treatment? *

Of these patients, what is your best estimate of how many received treatment directly from you or other clinicians in your facility? Enter a percentage 0-100 (Use only numerical characters). *

Of these patients, what is your best estimate of how many you referred out for external follow-up and treatment? Enter a percentage 0-100 (Use only numerical characters). *

How did you hear about this course?

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A Provider’s Pathway to Supporting Latino Patients with SUD