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* 1. Are you aware of our new flier for providers, “Tobacco Use Intervention: Rolling with Resistance” and our short video on the same topic?

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* 2. How did you learn of these materials? (Please select all that apply.)

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* 3. How would you rate the helpfulness of the flier?

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* 4. How would you rate the helpfulness of the video?

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* 5. If you rated either the flier or video as not helpful, how can we improve these materials in the future?

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* 6. Do you know about Quit for Life, our tobacco cessation program?

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* 7. How do you prefer to receive materials and information from PacificSource? (Please select all that apply.)

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