Register – learner – Opioid Assessment

This course does not include an accreditation certificate. It only includes a certificate of completion. Learners include: medical residents, fellows, nurse practitioner students, pharmacy students and other students.

Name *

First

Last

Email *

Email

Confirm Email

We encourage you to use a personal email address as work/private institution addresses could delay or prevent you from receiving the activation email

Password *

Password

Confirm Password

Please use a different password than your usual password as your account details will be emailed to you.

What is your age group? *

What is your Gender Identity? *

Gender - Other (please specify)

Please select your language preference: *

How did you hear about this program *

Please provide further details (eg. which conference, or presentation, etc)

Please select the option that best describes your role (select one): *

Role - Other (please specify)

Student Number *

Program Name *

Academic Institution *

What city is your practice or study located in? *

What Province/Territory is your practice or study located in? *

What is the postal code of your practice or study? *

What type of environment do your practice or study in? (Select all that apply. If more than one, please elaborate under “other”.) *

Type of environment practiced in - Other (please specify)