VDH Addiction Disease Management-VT Carilion School of Medicine

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* 1. Please provide your full name

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* 2. Title

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* 3. Enter your email address

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* 4. Confirm your email address

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* 5. This training includes a morning session of Virginia specific best practices for reducing opioid misuse. The optional afternoon session will include the first half live training to become waivered to prescribe Medication Assisted Treatment. The remaining portion of the MAT waiver training must be completed online post the live training within 45 days under the PCSS MAT curriculum guidelines.

Registration in the afternoon live session is limited to the first 12 participants. Upon registration, you will receive an email confirming your attendance in the afternoon session.

Do you plan to attend the afternoon session in MAT waiver content?

Yes, I plan to attend the afternoon session in MAT waiver content

No, I do not plan to attend the afternoon session in MAT waiver content

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* 6. If you are planning to attend the live afternoon MAT waiver training session, you will be provided lunch. Please indicate your dietary preferences.

I will not be attending the live afternoon MAT waiver training session.

I do not have any dietary restrictions.

Vegetarian

Gluten-free

Other (please specify)