* 1. The purpose of this survey is for Peer Assistance Services, Inc. (PAS) to gather opinions, identify practices and evaluate awareness around the issue of prescription drug abuse. This data will be used to develop an effective communication strategy targeted to prescribers of controlled substances regarding prescribing practices and prescription drug abuse. The resulting communication recommendations will include key messages, outreach opportunities and effective message delivery channels. All of your answers will be kept confidential and the reported results will only appear in aggregate.
Upon completion of the survey the first 125 participants will be mailed a $15 Starbucks gift card. Below, please fill in your name and the address where you would like your gift card mailed.

* 2. Check this box if you would like information sent to you around the issue of prescription drug misuse and abuse.