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FILL OUT THIS FORM, AND WE'LL GET RIGHT BACK TO YOU.
Filling out this form in no way commits you to purchase any of our services.

Please type in your response to each question. Please be as complete as you can, so we can
be of the most help to you.
NOTE: To make this form work, you MUST FILL IN "contact person" AND "phone," at the very
least. But, the more feedback you give us, the better.

What is your name (or your business name)? (Include any salutation, such as "Dr." or "Ms.".)


Name of contact person? (Include salutation.)


Your address?

Your phone number? (Include area code!)
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Of our services, which would be most helpful to you? Check all that apply. (Click once to check, twice to erase check.)

A. Research Summaries (To see Research Summaries page, click here.)
If you checked this, what topic areas do you need research summaries on?

For each topic area, for what time periods (by year quarters) do you need research summaries?

B. Outcomes Studies (To see Outcomes Studies page, click here.)
If you checked this, would you like to have us (check all that apply):
help you learn how to use outcomes study software
train you on how to do an outcomes study

C. Training (To see Training page, click here.)
If you checked this, please check which of our trainings would be most useful to you (check all that apply):
Dual Diagnosis
Research Methods
Outcomes Studies
Trauma and Prostitution
Smoking Cessation
Craving
Resistance
Addicted Women
Treatment Plans
Documentation
Neuropharmacology



Concerning your Educational Credits from either Training or Research Summaries,
check all the needed items:
Help with arranging Credits before in-person Training
Quizzes, to provide you with Credits from Research Summaries and written Trainings

Please add any Comments that you think would be helpful in your service inquiry:

Please remember that there are fees for our services. They are not set until you decide to contract for services with us.
You are not contracting with us by submitting this Interest Form. Please check our prices page.

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Once you submit this form, we'll get back to you to talk with you
about the items listed, costs, and particulars such as
whether you'd rather have training in person or written and
whether you need help arranging educational credits.

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Contact her by e-mail.