Global Healthcare Accreditation Needs Assessment Form - Healthcare Providers (2024)

Global Healthcare Accreditation Needs Assessment - Page 1

Instructions & Important Notes:

The form below will help GHA understand your current needs and how we can better support your business objectives. GHA accreditation, certification and advisory services are relevant to organizational programs often labeled as Global Patient Services, International Patient Services, Medical Tourism, Dental Tourism, Wellness travel, Medical Destinations Program or Medical Travel Services.

Should you have any questions, please contact Mr. Bill Cook at wcook@ghaccreditation.com.

Question Title

* 1. Please enter the information for the organization and the individual who should be contacted regarding the information submitted in this form.

Name of Organization

Primary Contact Name:

Primary Contact Title (position in the organization):

Primary Contact Email Address:

Primary Contact Phone Number:

City/Town:

State/Province:

ZIP/Postal Code:

Country:

Question Title

* 2. Please enter the following information:

Main Website Address:

Question Title

* 3. What type of organization?

In-patient hospital

Out-patient facility (e.g. ambulatory surgical center, dental clinic, etc...)

Other (please specify)