The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

MFkH47nQEYNHD5XTB864awVIDFYun

Center For Tobacco-Free Finger Lakes Training

Funded by the NY State Department of Health, all Train-the-Trainer support for your healthcare system and clinics is provided free of charge by the Center for a Tobacco-Free Finger Lakes, serving medical healthcare systems and mental healthcare systems in Monroe, Seneca, Ontario, Wayne Livingston, Schuyler, Chemung, Yates, Steuben counties. Train-the-Trainer content for your system's Tobacco Dependence Treatment includes: policies, treatment workflows, ongoing curriculum materials to choose from for your clinicians, and help with internal quality assurance metrics).

Please respond to the following brief questionnaire. This is not a committment to training, but it allows us to get information about your setting and address any questions.

Thank you for your time!

YOUR CONTACT INFO: Please provide your name and contact information (phone and/or email) so we may follow-up with you for training and/or to answer any questions.

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Is your setting Medical Health, Mental Health, or both?

Medical Health

Mental Health

Both

Not Applicable

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Please select the answer that best describes your current position.

If other, what is your current position?

Never

Sometimes

Always

Don't know

N/A

. . .provide counseling and support for patients/clients ready to quit using tobacco?

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. . .refer to NYS Smokers' Quitline and/or local cessation programs?

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. . .provide clinician training in tobacco dependence treatment?

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. . .provide assessment and feedback regarding clinical interventions with tobacco dependent patients?

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Would you like to set up a train-the-trainer session with your key clinicians and/or staff?
(Typically between 15 and 60 minutes, based on your setting / convenience)

Yes

No (or Not Sure At This Time)

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If yes for a training or to discuss further (no commitment), when would be a good time-frame for you?

Within the next 30 days

Within the next 3 months

Within the next year

Unsure, but we can discuss further

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Do you have any questions or comments for us?

Thank you for your time!

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.