Virtual CCN Education Event Intake Form
There are many medical centers within the PFF’s Care Center Network that have hosted in-person patient education events before, during, and after PF Awareness Month as a way to raise awareness, educate, and connect with patients, caregivers, and family members who are affected by pulmonary fibrosis. Given the current limitations to hosting in-person events due to COVID-19, the PFF is providing support to CCN sites that would like to host virtual patient education events using the PFF’s GoTo Webinar platform. We understand that many webinar platforms require a subscription and sometimes have limitations in how many attendees can participate in a virtual event.

So that the PFF can best accommodate the needs of CCN sites interested in hosting a virtual education event on the PFF's GoTo Webinar platform, please answer the questions below to assist in the scheduling process. If you would rather use a virtual event platform provided by your institution, please submit your contact information and the ways that the PFF can help you promote your virtual education event.
Email *
What is the name of the Care Center Network site that you are affiliated with? *
Please enter your name and contact information (email address and phone number) below: *
Please enter the name of a secondary contact that we can reach out to in regard to your event:
Are you interested in using the PFF's GoTo Webinar platform for hosting your virtual patient education event? *
Please indicate the date that you would prefer to host your virtual patient education event. *
MM
/
DD
/
YYYY
Please indicate the time that you would prefer to begin your virtual patient education event on the above date. *
Time
:
Approximately how long would you like your virtual event to last? *
hours
Would you be interested in collaborating with other CCN sites for your virtual event? *
If you have already discussed a collaboration with another CCN site, please list the name of the center(s) below:
If you choose to host a virtual patient education event, which ways would you like the PFF to assist in promoting your event?
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This form was created inside of Pulmonary Fibrosis Foundation.