Leaving the International HPH Network?

Please take a few moments to tell us why, so we can improve in the future.
Please indicate your reasons for terminating your HPH membership. If you wish, you can freely select only the fields that apply to your specific situation and your specific resignation.

Question Title

* 1. Member Hospital / Health Service name:

Question Title

* 2. Member Hospital / Health Service Coordinator:

Question Title

* 3. National / Regional Network name (if applicable):

Question Title

* 4. Date of resignation:

Question Title

* 5. Signature and date:

Question Title

* 6. Primary reason for leaving HPH is:

Question Title

* 7. HPH work in the organization has been:

Question Title

* 8. The future of HPH in the organization is:

Question Title

* 9. To have keept us onboard, HPH should:

Question Title

* 10. Further comments:

T