E-QIP Consultation Request Form

E-QIP Consultation Request Form

Please use this form to submit a request for a consultation with one of our coaches. Thank you for your interest in Consultations from E-QIP. You will hear back from a member of the E-QIP team within two business days to arrange a time to discuss your needs.

Our Program Coordinator may also connect with you to offer online resources and/or educational opportunities that are suited to the topics identified in your request form. If you have not received a response, please email us at quality@e-qip.ca

Name of Requesting Organization (full)*

Is your organization an AMHO member or a CMHA, Ontario branch?

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Name of individual requesting a consultation (first and last)*

What are your pronouns?

Contact email of individual requesting a consultation*

Which of the following best describes your organization 'type'?

Select or enter value

Please check the box below if both of the following statements are true (1) You identified your organization type as Child/Youth MHA AND (2) Your organization and your organization's services are funded by Ontario Ministry of Health and offer core mental health and addiction services to children and youth

As we endeavour to provide the most appropriate resource, your request for consultation may be redirected to the Knowledge Institute on Child and Youth Mental Health and Addictions.

Please check below if your organization has previously participated in an E-QIP offering (e.g. QI and data project coaching, CoP, previous consultation, governance and leadership training)

E-QIP offerings include QI and data project coaching, CoP, previous consultation and/or governance and leadership training

Please indicate which of the following topics your consultation request relates to (select all that apply)*

If your consultation request topic is not represented in this list, please write the topic you are requesting a consultation for in the space below

Select or enter value

Please use the space below to describe your QI/Data issue

How many individuals do you anticipate will be participating in this consultation?

One

Please include any relevant supporting documents below (ie/ deidentified data)

Drag and drop files here or

Please select which of the following E-QIP offerings you are interesting in knowing more about (if applicable)

Your assigned E-QIP coach will advise on how to register/request training on the offerings you have selected!

Select or enter value

Send me a copy of my responses

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