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Organization/institution

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Degree (As you want it to appear on your certificate) Required Required

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What is your profession? Required Required

Are you board certified by the American Board of Internal Medicine (ABIM)? Required Required

Which best describes your practice area? Required Required

How many years have you been in clinical practice? Required Required

Does your practice currently offer treatment for Opioid Use Disorder with buprenorphine and/or naltrexone? Required Required