PAI-2 Clinician Referral Interest Survey

PAI-2 Clinician Referral Program Interest Survey
Thank you for your interest in participating in the PAI-2 data collection.

To begin, please enter your first and last name. Then, let us know whether you are a licensed clinican. If you are not licensed, but work at a practice with a supervising clinician, please indicate that instead.
First and Last Name*

First NameLast Name
Are you a licensed clinician?*

YesNo, but I have a licensed clinician at my practice.I do not have a licensed clinician at my practice.
Do your clients reside in the United States?*

YesNo

Over the past few months, PAR has been collecting data for the PAI-2. As part of this project, we are now inviting clinicians to refer eligible participants.

If you’re a good fit for this opportunity, you’ll receive monetary compensation for each participant who completes the PAI-2 after you submit both a referral form (about 2 minutes) and a demographic form (about 10 minutes).

If you’re interested in participating, please answer the question below. Our data collection team will follow up with additional details, including the consent and release of information process.
I am interested in participating in the referral programI am not interested in participating in the referral program

To help us better partner with clinicians, please let us know why you determined that this project would not be a possibility for you.*
If the team was able to address your concerns, are you open to us reaching out to you again for this project?*

YesNo

Please provide the best email for us to reach out to you if we address your concerns. *
example@example.com

PAI-2 Clinician Referral Program Interest Survey