MOUD Champion Connection

Would you like peer support from a family physician around using Medication for Opioid Use Disorder (MOUD)? Whether you have a single question or you're looking for a partner to walk you through the process, we've got you covered. Complete the form below to be connected with a MOUD Champion. We will connect you with a family physician Champion in no more than five business days.

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

Have you begun been treating SUD/OUD patients with MOUD? If yes, for how long?

About MOUD

What questions or concerns do you have about MOUD?

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

Permission

May we share your contact information with selected individuals who have identified themselves as MOUD Champions?
Your contact information will not be released publicly and you may opt out at any time.

YesNo

Contact Information