Project ECHO Registration Form

Welcome to OSU-CHS Project ECHO! Please complete the form below to register to participate in the clinics. After you complete this form you will be contacted by email with instructions for attending the next TeleECHO clinic. Register at least two days before the clinic you plan to attend. You need to register to get continuing education credits for your participation in clinic. You only need to register one time. By registering, you will be contacted with information about how to participate in upcoming clinics in your interest area(s) each week.

Name Name First Last
Phone Phone - ### - ### ####
Email
Health Center / Organization
Job Title
Specialty

Ex.: healthcare/educator
Credentials
Physical Work Address Physical Work Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County
Which TeleECHO session(s) are you interested in participating in?
Healthcare ECHOs:

Which TeleECHO session(s) are you interested in participating in?
Healthcare ECHOs:
Addiction Medicine Help for the Healer ECHO Hepatitis C Maternal Health HIV/AIDS/Viral Disorders Infant Mental Health Obesity Medicine Pediatric Psychiatry Psychiatry Veteran Care ECHO None
Education ECHOs:

Education ECHOs:
TeleED - Educational Development - For School Administrators and Educators TeleSPED - Special Education TeleEDGE - Oklahoma State Department of Education TeleLEAD - for principals TeleNGAGE - for families/parents None
How did you hear about us?
By registering, you acknowledge and consent to participate as a community partner according to OSU Project ECHO’s conditions for collaboration.

By registering, you acknowledge and consent to participate as a community partner according to OSU Project ECHO’s conditions for collaboration. I agree to the above terms
You will receive an email confirmation upon submission.

In order to support the growth of the ECHO movement, Project ECHO ® collects participation data for each teleECHO™ program. This data allows Project ECHO to measure, analyze, and report on the movement’s reach. It is used in reports, on maps and visualizations, for research, for communications and surveys, for data quality assurance activities, and for decision-making related to new initiatives.

To learn more, click here.
Comments or Questions

Project ECHO Registration Form

Project ECHO Registration Form

You will receive an email confirmation upon submission.