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PMH Self-Assess

Thank you for completing the PMH Self-Assess Tool!

We will be using the data collected to help advocate for the allocation of more resources to physician practices.  There are no punitive actions coming out of sharing these results and your individual data will not be shared. 

Anything shared will be de-identified and aggregate.

All fields are necessary for reimbursement.


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* 1. Name

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* 2. Token 

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* 3. Preferred email address

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* 4. How long did you spend completing the self-assess tool?

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* 5. To support physicians to complete the tool, compensation up to one-hour is provided. Please indicate whether you will receive compensation from another organization for the time spent completing the assessment

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