Application for 2021 Academic Detailer Training

Apply to be trained as an Academic Detailer in Tennessee

Please complete this form if you wish to receive training that will equip you to engage clinical colleagues in your local community in one-on-one sessions designed to support appropriate prescribing of opioids and safe management of pain.

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* 1. Have you previously received training to serve as an Academic Detailer?

Yes

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* 2. Would you like to be considered for participation in Tennessee's Academic Detailing Program for 2021?

Yes

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* 3. What is your clinical background or profession?

pharmacist

physician

dentist

physician assistant

nurse

health educator

therapist

counselor

Other (please specify)

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* 4. In which county do you live and/or work?

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* 5. With what organizations are you affiliated / employed?

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* 6. Can you be available to participate in training from 12:00 - 4:00 pm CDT / 1:00 - 5:00 pm EDT on Tuesday May 4, Wednesday May 5 and Thursday, May 2, 2021?

Yes

Possibly

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* 7. How can we reach you regarding your participation in the Academic Detailing training and program?

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Application for 2021 Academic Detailer Training

Apply to be trained as an Academic Detailer in Tennessee

Question Title

* 1. Have you previously received training to serve as an Academic Detailer?

Question Title

* 2. Would you like to be considered for participation in Tennessee's Academic Detailing Program for 2021?

Question Title

* 3. What is your clinical background or profession?

Question Title

* 4. In which county do you live and/or work?

Question Title

* 5. With what organizations are you affiliated / employed?

Question Title

* 6. Can you be available to participate in training from 12:00 - 4:00 pm CDT / 1:00 - 5:00 pm EDT on Tuesday May 4, Wednesday May 5 and Thursday, May 2, 2021?

Question Title

* 7. How can we reach you regarding your participation in the Academic Detailing training and program?

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* 8. What additional information would you like to have regarding Tennessee's Academic Detailing Program?