Patient Experience Mapping - Request User Account

Request Access to the patient mapping toolbox

Please fill this form to request access to the patient mapping toolbox.

First Name(Required)

Last Name(Required)

Title(Required)

Organization(Required)

Email(Required)

Password(Required)

Enter Password Confirm Password

Please enter a password you can use to access this content

Describe how you will use the Patient Experience Mapping Toolbox(Required)

2 - 5 sentences.

I agree to the terms of service(Required)

I agree to reference the Patient Experience Mapping Toolbox and credit the National Health Council in all presentations and publications. Elements of the Patient Experience Mapping Toolbox should not be modified without approval of the National Health Council. Please email [email protected] for any questions.(Required)

I agree to provide feedback on the toolbox within 90 days of study/project completion, including modification to the interview guide questions and/or additions by emailing [email protected].(Required)

Hidden

User ID