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Vaccine Hesitancy Simulation Course Registration
1.
Name (First, Last)
2.
Email Address (please choose an email you want to use to access your course account)
3.
What country are you located in?
4.
What is your profession?
General Practitioner
Pediatrician
Infectious Disease Specialist
Nurse/Midwife
Other (please specify)
5.
Please tell us the number of years you have been in clinical practice.
6.
Do you give vaccinations regularly in clinical practice?
Yes
No, not regularly
No, not at all
Other (please explain)
7.
How often do you encounter vaccine hesitancy or refusal in your clinical practice?
Always or almost always
Sometimes
Rarely
Never or almost never
8.
How familiar are you with Motivational Interviewing (MI)?
Extremely familiar
Very familiar
Somewhat familiar
Not so familiar
Not at all familiar
9.
How familiar are you with the presumptive approach?
Extremely familiar
Very familiar
Somewhat familiar
Not so familiar
Not at all familiar
10.
Have you participated in any courses on vaccine hesitancy, the use of Motivational Interviewing (MI), or the presumptive approach in the past?
No
Yes (please share when)