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First Name *

Last Name *

Email *

Username *

Password *

Confirm Password *

Please indicate the state in which you currently practice *

Please indicate your provider type. *

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

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

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

Please indicate whether the facility in which you work currently screens for social determinants of health? *

Have you in participated in the A Provider’s Pathway to Supporting Latino Patients with Substance Use Disorder training in the past 12 months? *

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. *

How did you hear about this course?

A Providers' Pathway to Supporting Patients with SUD (Course D)