Health Check Report Card Enrollment Survey

1. Welcome

 
Thank you for your interest in the Health Check Report Card. We are pleased to provide you access to this tool for your use. Before you begin to use the tool individually or with your organization we ask that you provide us with some information. All of this information will be kept confidential and will only be used to help us to improve the Health Check Report Card.
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1. Please provide your contact information.
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2. How do you plan on using the Health Check Report Card?
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3. How many people will be using the Health Check Report Card?
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4. After utilizing the Health Check Report Card I agree that I will take the follow-up survey to provide information about my experience. In addition I will ask anyone in my organization who uses the Health Check Report Card to complete the follow-up survey as well. By selecting "YES" below you are agreeing to this statement.
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