Request For Training Form

MOTIVATIONAL INTERVIEWING FOR HEALTHCARE PROFESSIONALS

Please take a few minutes to answer these questions, which will help tailor the training request to the needs of your organization.

Contact Person

Organization

Telephone:

Email Address

Please select the type of training you were considering

1. What types of health care professionals will be attending the training?

2.What is the anticipated number of participants? (It may be possible to organize training for individuals or groups less than five by combining with other small groups).

3.What is your organization hoping to gain by offering the training?

4.Are there specific health related behaviors or conditions you hope the training will address?

5.How familiar will the participants be with the content of the training?

6.Did the participants request this type of training or did the management recommend/instruct their staff to participate?

Participants

Management

Please provide any additional comments that you think will help clarify the needs and expectations of those attending the training.

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Thank you for your enquiry