The Participating Clinic Contact Form must be completed by each clinic that will participate in the New York State Office of Mental Health Continuous Quality Improvement Initiative for Health Promotion and Care Coordination.
The submission of a completed form will confirm your clinic's participation in the Initiative.
Please complete the form as soon as possible.
If you have any questions about the survey, contact PSYCKES-Help at PSYCKES-Help@omh.ny.gov.
****PLEASE READ BEFORE PROCEEDING****
On the “Select Region” page, this survey will ask you to select the region in which your clinic is located. A drop down menu will list 5 OMH geographical regions and a State-Operated Clinic entry. After you select the region or state-operated clinic entry and advance to the next page, the survey will ask you select your agency and clinic from a list of agencies/clinics in a drop down menu. To view a map of the 5 OMH regions, click OMH Regional Map.
This survey will ask for information about key project contacts. Please make sure to have the name, title, phone number, and email address for the following project contacts before proceeding with the survey:
Clinic Director
Medical Director
Director of Quality Management/Quality Improvement (if applicable)
CQI Point Person 1
CQI Point Person 2 (if applicable)
Training Coordinator (if applicable)
Additional Project Team Members (if applicable)
If the above information is not readily available, please leave the survey by clicking “Exit” at the top right corner of your screen, and return to complete the survey.
To proceed click "Next" below.
