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* 1. Your job title

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* 2. How long have you been practicing in healthcare?

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* 3. I have had training in adoption-sensitive care. I have been trained how to care for families considering adoption (even at 2am on a Saturday night).

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* 4. If you have completed adoption-sensitivity training, where did you receive your training?

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* 5. I feel confident discussing adoption and providing information to my patients.

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* 6. If a patient wanted adoption information, I would know what to say and who to call.

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* 7. I would be interested in helping address how we support patients considering or pursuing adoption.

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* 8. Your name: 

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