Request for free downloadable file of the Speak Up™ video

Question Title

Please tell us about yourself and how you plan to use the Speak Up™ video(s). After you complete the information, you will be redirected to an FTP site to download the free video(s).

Name: *

Your title: *

Organization or company: *

City/Town:

State:

Country: *

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Your e-mail address:

Speak Up videos can be shown via closed-circuit TV or organization website or intranet for:
patient education activities
patients in their rooms
patients and families in waiting areas and cafeterias
health or safety fairs

Question Title

How does your organization plan to use the video(s)? Check all that apply.

We plan to run it in the cafeteria

We plan to run it in patient rooms

We plan to run it in the waiting area

We plan to show it on closed-circuit TV

We plan to show it on the employee intranet

We plan to post it to our website

We plan to use it at a health or safety fair

We plan to use it in our patient education activities

Other (please specify)

Question Title

Terms of use

©2014 The Joint Commission, all rights reserved. No modifications may be made to the downloaded material without the express written consent of The Joint Commission. Please check the box to indicate you agree.

Thank you for filling out this form. You may now download the video(s).