National Provider Identifier
What is your race? (Check all that apply)
WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsian IndianCambodianChineseFilipinoHmongJapaneseKoreanLaotianVietnameseNative HawaiianGuamanian or ChamorroSamoanDo not wish to discloseOther
Are you Hispanic, Latino/a, or Spanish origin
Do you see Medi-Cal patients?
Service Location Street
Service Location Additional
Service Location City
Service Location State/Province
Service Location Postal Code
Please identify your area of specialization
Have you completed the ACEs Aware “Becoming ACEs Aware in California” online training)? Certified Core Trainings include the Becoming ACEs Aware in California online training or a Core Training provided by one of the five following organizations: 1. Cottage Health (Pediatric Resiliency Collaborative), 2. Futures Without Violence, 3. Riverside County Department of Public Health, 4. The Children’s Clinic, or 5. UCSF Benioff Children's Hospital – Child and Adolescent Psychiatry Portal & Center for Community Health and Engagement.
YesNoNot yet, but I plan to in the next year.
If you are a Medi-Cal provider, have you attested to completing a certified ACEs Aware Core Training?
Are you screening patients for ACEs?