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Medical Providers Listening & Learning Session Interest Survey

Thank you for your interest in the Medical Provider Listening and Learning session. The session will take place on Tuesday, December 5 2023, 5:30-7:00 PM EST via Zoom.

For this session, we invite any medical provider who prescribes medication to girls and/or women with ADHD as part of their practice to participate. Please note that the primary audience for this session are medical providers who provide care to girls and/or women as part of their practice, but do not specialize in ADHD.

This is not a research study, but findings will inform future research studies.

To participate in this session, you must:

Attend the 1.5 hour session.
Have your camera on during the session.
Engage in the conversation during call (i.e., we want to hear your voice and your thoughts!)
Live in and participate from the United States.

Compensation will be offered to medical providers who actively participate in the full session.

What is your first name?

* must provide value

What is your last name?

* must provide value

What is your preferred way of being contacted?

* must provide value

Call

Text

What is your phone number?

* must provide value

What is your email address?

* must provide value

Please confirm your email address.

* must provide value

Which state do you live in?

What is your zipcode?

* must provide value

What is your race?

American Indian or Alaska Native

Asian

Black or African-American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

Multi-Racial

White

Prefer not to answer

None of these apply to me

If none of the previously listed races apply to you, please state your racial identity.

What is your ethnicity?

Are you available to attend the entire 90 minute virtual listening and learning session on Tuesday, December 5, 5:30-7:00PM EST?

I agree to turn my video camera on during the entire 90 minute listening and learning session.

Yes

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I agree to communicate verbally during the session.

Yes

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Please select what type of medical professional you identify as:

Please list the type of medical provider you identify as

* must provide value

Please list the type of advanced practice provider you identify as

* must provide value

Please indicate whether your clinical experience is with predominantly pediatric populations or adults?

Approximately how many years have you been in practice?

On a scale of 1-5, how would you rate your knowledge of ADHD in girls? (1=no knowledge at all, 5=extremely knowledgeable)

* must provide value

Change the slider above to set a response

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For verification purposes please include a link to your practice's website.

* must provide value

How did you hear about this listening and learning session?

* must provide value

Please tell us how you heard about this listening and learning session.

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.