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MAIA
CONSULTING GROUP
MI TRAINING INQUIRY FORM
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ABOUT
MOTIVATIONAL INTERVIEWING
WEIGHT-INCLUSIVE CARE
OUR SERVICES
CONTACT
WORK WITH ME
Contact Name
*
Organization Name
*
Email
*
Phone Number
*
Date
ORGANIZATION OVERVIEW
Briefly describe your organization and its mission.
*
What department or team is requesting this training?
*
What roles/job titles will participate in the training?
*
Physicians
Nurses
Behavioral Health Providers
Social Workers
Dietitians
Health Coaches
Case Managers
Peer Support Specialists
Other
How many staff members are expected to participate?
*
1-10
11-25
26-50
51+
TRAINING GOALS & FOCUS
What are your primary goals for this training?
*
Introduce foundational MI skills
Deepen MI skills (for those already trained)
Improve patient/client engagement
Support behavior change conversations
Improve team communication
Reduce burnout/improve practitioner confidence
Prepare staff for MI fidelity coding/supervision
Other:
What challenges are your staff currently facing in their communication or engagement efforts?
*
How familiar is your team with motivational interviewing?
*
No prior exposure
Some awareness, no formal training
Basic training completed
Advanced or follow-up training completed
Staff include MI trainers/supervisors
Which populations or topics are most relevant to your team’s use of MI?
*
Chronic disease management
Mental health or substance use
Health behavior change (e.g., nutrition, exercise)
Pediatric or adolescent care
Geriatrics/older adults
Caregiver or family communication
Other
TRAINING LOGISTICS
Preferred format for training:
*
In-person
Virtual (live)
Hybrid
Pre-recorded/asynchronous options
Preferred training length and structure:
*
2-3 hour workshop
Half-day (3-4 hours)
Full day
Multi-day series
Ongoing coaching/supervision
Not sure (would like guidance)
Ideal timeframe for scheduling the training:
*
Do you have a budget allocated for training?
*
Yes - estimated budget
No
Not sure yet
Are there specific outcomes or evaluation measures you need to meet (e.g., grant requirements, CE credits, performance metrics)?
*
ADDITIONAL INFORMATION
What would make this training most valuable to your team?
*
Is there anything else you’d like the trainer to know about your team, organization, or vision for this training?
*
Who is the decision-maker for this training (if different from the contact
*
How did you hear about us?
*
Referral from a colleague
LinkedIn
Conference or presentation
MINT website
Web search
Other
SUBMIT
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