The [Your Clinic] Wiki Template Access Request Form
The [Your Clinic] Wiki is free an open access to anyone who feels they may benefit from it. To gain access both to the template and free training materials, please fill out this form.
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Email *
First and Last Name *
Pronouns
Work email for us to send the instructions to: *
Name of the clinic you are considering bringing The [Your Clinic] Wiki to *
General location of your clinic (e.g. city and state) *
How did you hear about The [Your Clinic] Wiki? *
How many staff do you have? About how many administrators, front desk/support staff, nurses, clinicians, etc? *
Please tell us a little bit about your clinic, how it functions now, and why you are hoping to bring The [Your Clinic] Wiki to your staff. *
Disclaimer: The above Started Guide is a free initiative intended to help anyone use this free template who wants to. It is not expected to be an all encompassing training. Nor is Differential Design responsible for troubleshooting. Using this free, open access product is voluntary and Differential Design does not take any responsibility for how it is used by others. Get approval from your management team before implementing. If this resource isn’t for you, don’t use it. The Differential Design team is small. This open-access template was designed to be fully adopted by any requesting user without need for additional support. We do not have the capacity to provide technical support beyond making these materials available. You are welcome to learn from or get inspired by this Starter Guide and create your own Knowledge Management System completely from scratch. You are welcome to review this starter guide and decide that this template does not work for your clinic. But if you find this helpful, you are welcome to use it however you feel fits best for your operations. The product is simply a template that you may use or decide not to. Any adoption of the template is fully your own. You and your clinic are solely responsible and accountable for its use.
By submitting this form, I agree to the above disclaimer, understand that The [Your Clinic] Wiki is provided in a good faith effort to support those who may benefit from it, but that my decision to utilize this open source resource is completely my own, that Differential Design has no responsibility nor accountability for how I use it, and is not expected to provide any individual support. I agree to fill out surveys to help Differential Design understand how the tool is being utilized so they can continue to work to improve free, open access products like these. *
Do you have any questions?
Soon after receiving this form, you will get an email with a Starter Guide. Please follow those directions to access all materials.
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