Request for free downloadable file of the Speak Up™ video
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).
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:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
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GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
Country:
Your e-mail address:
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
How does your organization plan to use the video(s)? Check all that apply.
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)
Terms of use
Terms of use
©2011 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).
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