Yale New Haven Health System Center for Emergency Preparedness and Disaster Response (YNHHS-CEPDR) Questions or Comments: (203) 688-5000 or Email Please complete the form below. Upon submission, you will be redirected to "CDC EMS Checklist for Ebola Preparedness" PDF download. Question Title * Please complete your contact information. Name: * Company: * Job Title: Address: City/Town: State/Province: * ZIP/Postal Code: Country: Email Address: * Phone Number: Question Title * Would you be interested in learning how YNHHS-CEPDR can assist your organization with emergency preparedness activities. Yes - Open Source Tools Yes - Consulting Services No Other (please specify) Question Title * Rate on a scale from 1 - 10 (10 being fully prepared) what you believe your organization's level of preparedness is for Ebola. Not Prepared Neither Prepared or Not Prepared Fully Prepared Not Prepared Neither Prepared or Not Prepared Fully Prepared Question Title * Additional comments or questions. Done