We are currently accepting registration for:
2021 Spring Sessions
February 2-4, 2021

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* 1. Contact Information

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* 2. Did you attend our BTI Training in November 2020? If yes, please specify which training.

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* 3. Which dates do you plan on attending?

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* 4. BTI is a targeted training system for staff of Arkansas Federally Qualified Healthcare Centers. Are you currently employed with an Arkansas FQHC that provides tobacco cessation counseling?

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* 5. Are you registering as an individual or a group?

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* 6. (Group registration only). Please list Name, Credentials, and Email Address on separate lines for each participant in order for us to contact you.

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* 7. Please complete this quick survey to help ACC design programs to help healthcare providers better assist patients who use tobacco.  
 
Does/would your clinic or healthcare system:

  Yes No
Provide tobacco/nicotine cessation counseling to patients?
Receive reimbursement for tobacco/nicotine counseling through Medicare, Medicaid or private insurance?
Be interested in implementing health system change for patients who use tobacco/nicotine?
Be interested in hosting/attending a free tobacco cessation training?
Be interested in obtaining free Continuing Education Credits?
Be interested in receiving information on how to bill/code for tobacco cessation counseling?
Be interested in receiving a free Carbon Monoxide monitor?
Thank you for your application. ACC will contact you with more details.
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