Thank you for participating in the Patient Experience Month Film Festival! We are excited for you to show off how your team AMPLIFIES UNITY! Please complete the form below and submit no later than March 23rd 2020.

Remember to abide by Texas Children’s recording policies including the necessity to have a consent form on file for any patient or family member who is included in the video.

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* 1. Primary Contact Name

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* 2. Primary Contact Email

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* 3. Name of Department/Unit/Clinic/Team represented in video

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* 4. Please list the names of team members who contributed/were featured in the video:

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* 5. Please upload your submission to YouTube and copy and paste link here: (YouTube video instructions can be accessed here. Please set privacy settings at unlisted)

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