PlacementPro Facility User Request Form

Clinical Placement Tool for Scheduling

New Facility PlacementPro User Request Form

Congratulations on completing Partner Training. You are now ready to request your PlacementPro account. Note that this form is for FACILITY Users! You will need the 2 clues and completion code you saw in the training content.

Name(Required)

First Last

Office Phone(Required)

Mobile Phone

Enter this number if appropriate for contact purposes!

Email(Required)

Your full email address will become your username for PlacementPro!

Facility Name(Required)

Enter the full name of your Facility or Health System.

If you are a Health System with multiple locations, list ALL facilities/locations that you will be responsible for managing placements or vetting student/instructors.

State(Required)

Tennessee

Georgia

Alabama

Mississippi

Arkansas

Kentucky

North Carolina

What is the scope of your placement management?(Required)

Scope Details

Related to your scope of management answer above, list the specific campuses, departments, practices, clinics, etc. that are your responsibility.

Choose Your PlacementPro ROLE:(Required)

Clinical Users have full use of PlacementPro to approve and add placements, AND vet students' and instructors' clinical requirements for approval or rejection. HR Users can only vet clinical requirements. Departmental Directors may only review students assigned to the specific department.

What level of user are you?(Required)

Primary Users are a main point of contact and use PlacementPro most often. They receive automated mail from the system. Backup Users use the PlacementPro system occasionally to assist the Primary Users. They may or may not receive email from the system. HR Users typically do not receive email notifications so you should choose Backup for this question.

Enter Clue #1 from the training!(Required)

This clue was in Part 1 of the New Partner Training!

Enter Clue #2 from the training!(Required)

This clue was in Part 2 of the New Partner Training or CRM Training depending upon your role!

Enter your training Completion Code!(Required)

The completion code was in Part 2 of the New Partner Training or CRM Training depending upon your role!

Additional information:

Is there any other information that we need to know related to account request? If so, provide this information below.

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PlacementPro Facility User Request Form

New Facility PlacementPro User Request Form

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