OHCQ Presentation Request

Please submit this form to request a presentation from the Office of Health Care Quality.

An OHCQ team member will contact you via email or phone within two business days of your request.

Name of organizer:*

Email of organizer:*

Phone number:*

Phone

Name of organization or group, if applicable:

Proposed Topic

Overview of Office of Health Care Quality

Other

Type of Presentation*

Online

In-person

Room number:

Street address:

City:

State:

Zip code:

How many participants are expected?

< 10

11 - 25

26 - 50

51 - 100

> 100

How long do you anticipate the presentation will be?

60 minutes

90 minutes

120 minutes

1/2 day

Full day

Please enter any additional information about your request:

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