Registration: Preparing your Health Center for SBIRT Implementation

Name*

First Last

Organization*

Position/Role*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone Number*

Email Address*

By providing your email address, you will be added to the Mountain Plains ATTC mailing list; to opt-out, please contact mpattc@casat.org

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Strength indicator

Are you currently implementing SBIRT in your organization and/or practice?*

Note: The intended audience for this series are community health workers, behavioral health providers, medical assistants, nurses, primary care, and other medical care providers currently using SBIRT or in the process of implementing SBIRT in a healthcare setting

Yes
No

Do you have a background or have you attended SBIRT training?*

Yes
No

If yes, please explain.*

What do you hope to learn by participating in the SBIRT-IP series?*

How did you learn about this event?

Are you Hispanic or Latino/a

Yes
No
Prefer not to answer

What is your race?

Specify*

By checking below you are indicating that you understand the technology requirements and participant commitment as follows*

Attend the one-hour orientation, commit to 6-weeks of training, complete weekly learning activities, and actively participate in discussions each week.

I understand the time commitment involved and agree to fully participate.
By checking here, you are allowing to receive SMS messages from the Mountain Plains ATTC. As part of additional engagement with this learning series, weekly SMS messages will be sent out 3-4 times weekly based on session content. Message and data rate apply. Reply STOP to opt out or HELP for help