Survey on RX Privileges for Properly Trained Psychologists
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Please indicate your level of endorsement for legislation granting prescriptive authority for appropriately trained psychologists:
Strongly Supportive
Supportive
Neutral
Opposed
Strongly Opposed
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Would you be willing to participate in organizing to support prescription authority for psychologists?
Definitely
Probably
Maybe
No
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Are you a member of a State Psychological Association?
Yes
No
If yes, which state?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Highest Level of Training Completed:
BA/BS
MA/MS
PhD/PsyD/EdD
Licensed Psychologist
Yes, I want to learn more! Please send me information on:
CSPP at Alliant Postdoctoral Master of Science in Clinical Psychopharmacology
Continuing Education at Alliant Psychopharmacology Workshops
If you are interested in taking Psychopharmacology (RxP) courses or workshops, which location(s) do you prefer?
Baton Rouge, LA
Fresno, CA
Irvine, CA
Los Angeles, CA
Portland, OR
Sacramento, CA
Salt lake City, UT
San Diego, CA
San Francisco, CA
Other Distance Site:
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NAME:
STREET ADDRESS:
CITY, STATE, ZIP
DAYTIME PHONE:
EVENING PHONE:
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E-MAIL ADDRESS:
Comments
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Indicates Response Required