Thank you for your interest in attending DMH's PACT Provider Listening Session. Your feedback is extremely important! A registration link will be forwarded following your registration.

For additional questions, please contact: Michael.Stepansky@mass.gov.

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1. Please enter your full name. (Required.)

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3. Please indicate if you require an accommodation or translation service. (Required.)

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4. If you are choosing to participate in a listening session, please acknowledge the following:

I understand that by participating in this DMH Listening Session, I am potentially disclosing personal health information, including DMH-affiliation, related to a family member to other members of the listening group. By checking the "Yes" box, I acknowledge that I understand this and agree to keep personal information to the minimum necessary and keep confidential any information related to specific individuals outside of the listening session. (Required.)

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5. If you are not participating in a listening session but are providing consent as a guardian for another person to participate, please indicate your consent for the person's participation below. (Required.)

Thank you! A registration link will be shared with you shortly.

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