Thank you for requesting a consultation with the UT Health San Antonio Dissemination & Implementation Consultation Core.

To better serve you, we request that you provide the information below. This form should take approximately 10 minutes to complete. The information provided in this form will be used by our consulting team to prepare for your consult appointment. De-identified and aggregated information from this form may also be used for program evaluation or research purposes.

This survey is adapted from Dissemination and Implementation Science Consultation Electronic (DICE), a set of tools to support efficient and effective D&I science consultations at Clinical Translational and Science Award (CTSA) programs. Learn more about the UT Health San Antonio CTSA here.

For resources and more information about the D&I Consultation Core, please visit us online.

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