Printable Study Flyer Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *How old are you? *Address *City, State and Zipcode ONLYWhen are the best days and time to contact you? *Do you consent to be contacted by the research team for this clinical trial? *YesNoAre you seeking treatment for Opioid Use Disorder? *YesNoHave you been treated with any medication for your OUD in the last 3 months? *YesNoHave you been treated with long-acting naltrexone such as Vivitrol® or ReVia® in the past 12 months? *YesNoHave you been treated with long-acting buprenorphine such as Brixadi® or Sublocade® medication in the past 24 months? *YesNoDo you have any diagnosis other than OUD that requires the use of chronic opioid treatment? *YesNoHave you experienced an opioid overdose event? *YesNoHave you been ordered by a judge, parole officer, or any legal entity to undergo OUD treatment? *YesNoDo you use substances via injection more than 2 times per week, on average? *YesNoSubmit
