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October '22 CHoSEN Forum Registration Form

CHoSEN Forum Registration: Thursday, October 20th, 2022

PLEASE NOTE: In-person registration has closed, but you may still register to attend virtually. If you would like to attend in-person, please reach out to Cassie Davis at cdavis@illuminatecolorado.org. 
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4. Have you attended a CHoSEN Forum in the past? *This question is required.
5. Do you work in a healthcare (physical or behavioral) facility? *This question is required.
Is your healthcare facility currently implementing CHoSEN QIC interventions?  *This question is required.
What type of healthcare services does your facility provide? *This question is required.
In what type of healthcare setting(s) do you work?
*select all that apply *This question is required.
With which population(s) do you work?
*select all that apply *This question is required.
Which of the following best describes the type of position you hold? *This question is required.
From what primary perspective are you participating in this event? *This question is required.
7. In which county(ies) do you engage in work related to substance use and pregnancy/families? (*Select all that apply.) If your work is statewide, please select 'Statewide'. If you work outside of Colorado, please select 'Outside of Colorado' and specify your geographic location. If you are not employed in a capacity that is related to substance use and pregnancy/families, please select the county/area in which you live.
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