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* 1. Your Name

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* 2. Your Title

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* 3. Your Clinic’s Name & Address

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* 4. Your Direct Phone #

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* 5. I have an understanding of ACEs, resilience and trauma informed care

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* 6. I believe that ACEs and resiliency screening is important in pediatrics

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* 7. I have received training and/or education on ACEs and Resiliency

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* 8. What are the challenges you foresee to implement processes around screening, referrals, and education for ACEs and resiliency?

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