Clinici.wiki Contact Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hi there! We officially launched clinici.wiki at SGIM 2022 on April 7th! We hope you find this new free, open-access resource useful. Since this is so new, I'd really love it if you'd please fill out a brief contact information form so we can have a sense of who is using it. We'll also notify you when we launch our free clinic Knowledge Management and Workflow Optimization resources though www.ddn.health if you'd like us to. Thank you!

First Name *

Last Name *

Email Address *

Academic Institution/Employer *

I am a *

Medical Student

Medical Resident

Fellow

Attending

Program Director/Assistant Program Director

Clinic Medical Director/Assistant Medical Director

Non clinician working in medical education (please provide title below)

Non clinician working in medical administration/management (please provide title below)

Other:

Required

I took a look at www.clinici.wiki and:

Will think about using it

Already intend to incorporate it into my clinical practice

Will look forward to sharing it with my colleagues at our teaching clinic

Don't think I'll really use it much at all

Other:

I am interested in getting updates about clinici.wiki and other free open access health tech, health management, and health design resources your team at Differential Design is creating (www.ddn.health). (No spam or newsletters, genuinely just notifications when we launch new free resources). *

Yes

Other:

Any other comments, suggestions, feedback? Have ideas for collaboration or just want to chat more?

Thanks so much. These are all new initiatives simply to make the lives of primary care providers easier so we can spend more time caring for the humans in front of us. Not selling anything. Not planning on monetizing any of these resources. Never plan to put anything behind a pay wall. So any and all feedback is very welcome! -Aaron

If you have content suggestions for www.clinici.wiki, please submit them here: https://forms.gle/E5gYU1md8WFxKWS49

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms