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1. Name (First, Last)

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2. Email Address (please choose an email you want to use to access your course account)

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3. What country are you located in?

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4. What is your profession?

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5. Please tell us the number of years you have been in clinical practice.

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6. Do you give vaccinations regularly in clinical practice?

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7. How often do you encounter vaccine hesitancy or refusal in your clinical practice?

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8. How familiar are you with Motivational Interviewing (MI)?

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9. How familiar are you with the presumptive approach?

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10. Have you participated in any courses on vaccine hesitancy, the use of Motivational Interviewing (MI), or the presumptive approach in the past?

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