Request an online focus group session using the form below. Your request will be submitted and reviewed by CHIME Foundation staff who will be in touch with your request status within 1-2 business days. Point of ContactName* First Last Title*Foundation Organization*Email* Phone*Focus Group DetailsPlease choose three (3) desired dates and times (2pm or 4pm EST).*Online Focus Groups are only held on Tuesdays and Thursdays either at 2pm or 4pm EST. Example: 5/25/19 at 2pm EST. Please note these are subject to availability.Date/Time 1Date/Time 2Date/Time 3 Title*Abstract*3 Learning Objectives*Target Audience* CIO CMIO/CNIO International Opioid engaged members Small/rural providers Large provider organizations All CHIME members Speaker InfoSpeaker 1Name* First Last Credentials Organization*Title*Email* Speaker 2 (if applicable)Name First Last Credentials OrganizationTitleEmail PhotoAccepted file types: jpg, gif, png.