JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Recovery Focused Practice: The Role of Medication in SUD Treatment - November 18, 2022
To evaluate the educational activity and receive a CME Transcript, please complete this survey.
Questions with an asterisk are mandatory.
* Indicates required question
Email
*
Your email
Please enter your full name
*
Your answer
Please check the appropriate designation.
*
Choose
Counselor
Pharmacist
Social Worker
Physician
Other
CME Passport (Physicians Only)
Based on the CME Passport information you received in your attendee packet, do you give the Medical Association approval to report your participation in this activity to the ACCME?
*
Yes
No
N/A
State of Licensure
Your answer
State License ID number
Your answer
Date of birth (mm/dd)
Your answer
Next
Page 1 of 10
Clear form
Never submit passwords through Google Forms.
This form was created inside of MEDICAL ASSOC OF THE STATE OF AL.
Report Abuse
Forms