Health in Our Hands Community Sign-Up
Thank you for your interest in Health in Our Hands. Health in Our Hands (HiOH) seeks to build a collective of committed and passionate patients to engage with research, share their experiences and perspectives, and drive innovations in healthcare. Health in Our Hands is a community that:
  • Recognizes individuals as the experts of their own health experience.
  • Brings patients, doctors and researchers together to advance patient-centered research.
  • Provides opportunities to inform the research community about health issues that are important to patients.
At HiOH, we feel that diversity is something to be celebrated. Diversity strengthens research by allowing us to examine the impacts of diseases and effectiveness of treatments on all people, including populations that are often underrepresented in health research. We strive to include individuals from all walks of life in our studies.

Please respond to the questions below to the best of your ability. We will be in touch regarding your interest in joining the Health in Our Hands community.
Sign in to Google to save your progress. Learn more
1. Preferred name (first and last) *
2. Gender Identity *
3. Preferred Pronouns *
4. Race *
5. Date of Birth *
MM
/
DD
/
YYYY
6. Zip Code *
7. In between meetings, HiOH primarily communicates with members via email. Please share your preferred email address, the one that you check most regularly.  *
8. Phone Number (Primary) *
9. How did you hear about Health in Our Hands (HiOH)? 
Clear selection
10. If you were referred by a current HiOH member, please write their name in the space below. 
11. HiOH meets bi-monthly on Zoom. Are you comfortable using Zoom? 
Clear selection
12. Do you have any concerns about using Zoom for virtual meetings? Please explain in a few sentences.
13. Have you ever participated in health research?
Clear selection
14. If you answered yes or unsure, please tell us about your experience (i.e. research topic, time period, provider, etc).
15. What health conditions are you most interested in?
16. Are you available for virtual meetings on weekdays during the daytime (between 9am and 4pm)?
Clear selection
17. Are you available for virtual meetings on weekdays in the evening (after 4:30pm)?
Clear selection
18. Do you receive care from any of the following health systems? 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy