Skip to content

PA OPIOID OVERDOSE REDUCTION 
Stigma Reduction Initiative

Baseline Survey of Medical Professionals and Practice Behavior Assessment

DEMOGRAPHICS
1.Please indicate the date of survey:
Date / Time
2.Please indicate your age:
3.Please indicate your gender:
4.Please indicate your race:
5.Please indicate your healthcare discipline:
6.Please indicate where you practice (select more than one if applicable):
7.Please describe the majority of your shifts (select more than one if applicable):
8.Please indicate the best description of the area in which you serve:
9.Please indicate your length of time serving as a healthcare professional:
10.Please indicate your zip code of residence:
Current Progress,
0 of 74 answered