Public Health Detailing Request Form

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Public Health Detailing (PHD) is a free educational opportunity for clinical providers in the state of Colorado. The goal of Detailing is to provide updated, evidence-based clinical practice guidelines and resources to providers in an efficient and practice-friendly format.

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Tell us more about you!

Name (please include your credentials!) *

Email address *

Phone *

Practice Name *

What best describes your clinical practice and/or facility setting? *

Primary Care Clinician and/or Facility

Family Planning/Sexual Health Clinician and/or Facility

Emergency Department/Urgent Care Clinician and/or Facility

Infectious Disease Clinician and/or Facility

Pediatric Clinician and/or Facility

Hospitalist/Internist

Academic Faculty and/or Facility

Community-Based Organization

Local Health Department

School-based Clinic

Other:

Required

Zip Code *

County of Practice *

How many Prescribing Clinicians are within your practice? *

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