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Pain Management & Opioids: A Patient-Centered Approach

AHEC CE Participant Registration Form

Information for this form is provided voluntarily. AHEC is required to report information about program participants. Data will be kept private to the extent allowed by law and will be referenced periodically to evaluate the effectiveness of AHEC services and programs. We appreciate your cooperation in the completion of this form.
The AAFP has reviewed Pain Management and Opioids: A Patient-Centered Approach, and deemed it acceptable for AAFP credit. Term of approval is from 05/01/2025 to 10/31/2025. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
1.Which session would you like to attend?(Required.)
2.Participant's Name(Required.)
3.Employer Name(Required.)
4.Work/Practice Location Address
5.Work/Practice Location County
6.Primary Phone # (Required.)
7.Permanent Email address (Required.)
8.Number of years/mos. worked at this site ____ yrs ____mos.
9.Do you currently serve as a preceptor for students? (Required.)
10.Name of health professions school attended, if applicable:
11.Year of Graduation
12.As a student, did you participate in a rural or community rotation? 
13.Do you plan to apply this training toward your employment requirements, continuing education credit, certification, or credentialing?
14.Do you have any dietary restrictions?
15.Are you currently a student?
16.Please select your profession (if applicable, the profession you are applying this CE credit toward) or your field of study (if student) from the list.
Current Progress,
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