Participation Request Form
|Please note that there are three different versions of the Participation
Form. Be sure to read the categories below and choose the version of the form that
corresponds to your organization.
Please complete and submit only one Participation Form:
- For hospitals requesting to self-administer the HCAHPS Survey please
to complete the Self-Administering Participation Form.
- For hospitals requesting to administer the HCAHPS Survey for multiple hospitals,
to complete the Multi-site Participation Form.
- For survey vendors requesting to administer the HCAHPS Survey on behalf of contracted
to complete the Survey Vendor Participation Form.