Thank you for your interest in the Oregon Health Authority's needs assessment interviews for technical assistance to providers of physical, behavioral, and dental health services. Your responses to these five brief questions will help ensure that we talk to a broad sample of providers across Oregon. OHA staff will contact you to follow up.

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* 1. Clinic name

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* 2. Clinic type

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* 3. City

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* 4. Main contact name

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* 5. Main contact e-mail

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* 6. CCO Affiliation

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