Caring for America's Veterans
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Special Program for Clinical Providers of Veterans

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The Oklahoma Geriatric Education Center has partnered with the Veterans Affairs to offer Veterans' health education to clinical providers.

Short webinars (~20 mins each) on Depression, PTSD, and Alcohol Use Disorder can be viewed here: www.ouhsc.edu/geriatricmedicine/okgec/webinars.asp

After you view a webinar, we can send you two clinical reminders on key points, plus participation incentives.

Please enter your preferred method of reminder delivery (email address or postal address).

Many thanks,
Tom Teasdale, DrPH
Director, Oklahoma Geriatric Education Center
405-271-8199
thomas.teasdale@va.gov

*
1. Which webinar(s) did you view?

Which webinar(s) did you view? Depression

PTSD

Alcohol Use Disorder

2. What is your email address? We will use this information to send you two reminders of key clinical content from the webinar material.

What is your email address? We will use this information to send you two reminders of key clinical content from the webinar material. Email Address:

3. ...or enter preferred postal address for paper-based reminders.

...or enter preferred postal address for paper-based reminders. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Phone Number:

4. Please endorse the following:

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
The content of the program was appropriate for me.	*Please endorse the following: The content of the program was appropriate for me. Strongly disagree	The content of the program was appropriate for me. Disagree	The content of the program was appropriate for me. Neutral	The content of the program was appropriate for me. Agree	The content of the program was appropriate for me. Strongly agree
The program has led to new ideas that I will try out in my work setting.	The program has led to new ideas that I will try out in my work setting. Strongly disagree	The program has led to new ideas that I will try out in my work setting. Disagree	The program has led to new ideas that I will try out in my work setting. Neutral	The program has led to new ideas that I will try out in my work setting. Agree	The program has led to new ideas that I will try out in my work setting. Strongly agree

5. What is your most advanced degree?

What is your most advanced degree?

6. Your Discipline or Profession:
(Choices determined by Federal funding agency)

	Primary Care Professions	Allied Health	Related Health Professions
Select one profession only:	Your Discipline or Profession: (Choices determined by Federal funding agency) Select one profession only: Primary Care Professions	Allied Health	Related Health Professions

Other (please specify)

7. Your Gender

Your Gender Female

Male

8. Your Age

Your Age Under 20

20-29

30-39

40-49

50-59

60+

9. Your Ethnic Background

Your Ethnic Background American Indian/Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White