MOUD Champion Invitation

Do you use Medication for your patients with Opioid Use Disorder (MOUD)? You can be a MOUD Champion and share your expertise with peers seeking to build MOUD/MAT (Medication Assisted Treatment) into their practices.

This program is sponsored by the California Academy of Family Physicians (CAFP) and supported by the National Institute on Drug Abuse (NIDA) and the California Department of Health Care Services (DHCS).

If you have questions about this form or the MOUD Champion Initiative, contact Laurie Isenberg, CAFP Director of Education and Leadership Development at Lisenberg@familydocs.org.

Personal Information

AAFP/CAFP ID# (if applicable)

First Name

Last Name

Degree (MD/DO/MPH)

Specialty

Email Address

Phone Number

Practice Information

Type of Practice (Solo, Small, Medium, Large)

City

County

On average, how many patients do you see or treat for SUD/OUD per month?

How long have you been treating SUD/OUD patients with MOUD?

Testimonial

What drives you to be engaged with MOUD in your practice?

Champion

May we share your contact information with selected individuals who wish to be connected with a MOUD Champion?
Your contact information will not be released publicly and you may opt out at any time.

YesNo

Contact Information