Hospital Registration

We apologize, but due to unforseen circumstances, our online form is currently offline. We expect to have it operational again shortly.

In the mean time, please contact us via email at with the following information:

  • Hospital information
    • Hospital Name
    • Address 1/2
    • City, State, ZIP
    • Medicare ID
    • Number of Beds
    • Is your hospital a teaching hospital?
    • Is your hospital a member of a system?
    • Is your hospital publicly owned, not for profit, or for profit?
  • Contact Person
    • Contact Name
    • Title
    • Contact Email (if different than the sending email address)
    • Contact Number
    • Date you would like to begin HLQAT