Attestation of Completion of Provider Training

Question Title

I understand that I must save or print a copy of this attestation for my records, and that Riverwood Center will not retain a copy on my behalf.

Please note: It is up to the user to "zoom-out" on the browser of their choice to see this full form on their screen. Users will need to complete a screen print or "snip" to see the text they have inputted when saving the screenshot to PDF, as an image, or printing the completed form.

Yes, I will retain a copy and/or print for my records.

Question Title

I confirm that I have completed the Riverwod Center, Berrien Mental Health Authority Compliance, PCP, Cultural, and Customer Service slide reviews. By accepting below I hereby attest that I have fully reviewed the trainings required of me as listed above.

Yes, I accept, and confirm that I have fully reviewed the required information.

Question Title

Please indicate when you completed the review of materials.

Date / Time

Date

Time

AM/PM

Question Title

Please supply your electronic signature.

First Name

Last Name

Question Title

Please indicate which organization you are employed by.

Question Title

Please enter your professional eMail address.

Thank you for completing the attestation of Provider Training for Riverwood Center, a division of the Berrien Mental Health Authority.