:: Practitioner Questionnaire

NAADAC
PRACTITIONER QUESTIONNAIRE

Thank you for your interest in participating in the NAADAC
Practitioner Research Network Questionnaire.
Please enter the following information to begin the survey:

	First Name*
	Last Name*
	E-mail address* (or a PIN number at least 5 digits long, if you don't have e-mail)
	ZIP code*
Date of Birth*	Year:

*	This information is being collected in order to determine whether your participation in the survey is as a randomly selected participant or a voluntary respondent. Your e-mail address is used for tracking purposes only and your personal information will never be given to a third party.

YES NO

Did you receive a letter requesting your participation in this study?