Information to be collected
Zip code*
Email address*
Profession (Select one)*
Healthcare professional student |
Doctor (M.D. or D.O.) |
Nurse/Nurse Practitioner |
Resident |
Physician Assistant |
Physical Therapist/Occupational Therapist |
Dentist |
Pharmacist |
Other |
Specialty (Select one)
Family Medicine |
Pediatrics |
OB/Gynecology |
ENT/Otolaryngology |
Pathology |
Emergency Medicine |
Preventive Medicine |
Psychiatry |
Radiology |
Anesthesiology |
Dermatology |
Neurology |
Pain Medicine |
Physical Medicine & Rehab |
|
Internal Medicine |
||
Internal Medicine (subspecialty) |
||
Nephrology |
Cardiology |
Rheumatology |
Neurology |
Hematology/Oncology |
Infectious Disease |
GI |
Geriatrics |
Other |
Surgery |
||
Surgery (subspecialty) |
||
Plastic |
Thoracic |
Urology |
Ophthalmology |
Orthopedic |
Other |
|
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Other |
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Open text questions
Question 1: How has the prescription opioid crisis impacted you, your practice, or your patients? (open text box)
Question 2: What have you found to be effective strategies to address the prescription opioid crisis in your clinic and/or community? (open text box)
*Required information
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Harris Qureshi |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |