SBIRT in Medical Offices

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* 1. How would you rate your knowledge of SBIRT prior to viewing the training video? Please rate on a scale of 1-10, with 1 being no knowledge and 10 being extremely knowledgeable.

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* 2. How would you rate your knowledge of SBIRT after viewing the training video? Please rate on a scale of 1-10, with 1 being no knowledge and 10 being extremely knowledgeable.

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* 3. How would you rate your confidence in using SBIRT prior to viewing the training video with 1 being no confidence and 10 being completely confident?

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* 4. How would you rate your confidence in using SBIRT after viewing the training video with 1 being no confidence and 10 being completely confident?

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* 5. How likely are you to implement SBIRT in your practice after viewing this video?

Very likely

Likely

Somewhat likely

Neither likely nor unlikely

Somewhat unlikely

Unlikely

Very unlikely

If you answered that you are unlikely to implement SBIRT, please let us know why.

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* 6. Would you like a more in-depth SBIRT training on how to implement and use SBIRT in the medical office setting?

Yes

No

If yes, please include your contact information below:

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* 7. After viewing this training video, you are eligible to receive 1 general CEU credit. If you would like to receive a CEU certificate for this session, please complete the information below and we will send you one electronically.

Full Name

Workplace Name

License Number

Email Address

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* 8. Please leave any additional feedback you may have about SBIRT and this video training in the space below. Thank you.