AAP Online Toolkits Access Request

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Please complete this form to request access to any of the following online AAP Toolkits: ADHD, Autism, and/or Mental Health Toolkits. We will respond within 5 business days with access information.

The Maternal and Child Health Unit at the Wyoming Department of Health has paid for institutional access to these toolkits in order to make access free for Wyoming providers.

The required questions collect data necessary for reporting on the federal grants that fund access to these toolkits. Your personal identifying information is needed for us to ensure that we are reporting unduplicated numbers and that you are a Wyoming-based provider, and will not be shared in any federal reporting.

If you have any questions, please contact Megan Selheim at megan.selheim@wyo.gov.

Email *

First and Last Name *

Please share your provider type. *

Pediatrician MD/DO

Family Medicine MD/DO

OB/GYN MD/DO

Internal Medicine MD/DO

Advanced Practice Nurse/Nurse Practitioner

Certified Nurse Midwife

Physician Assistant

Psychiatrist

Developmental-Behavioral Pediatrician

Nurse

Behavioral Health Clinician (e.g., psychologist, therapist, counselor)

Care Coordinator/Patient Navigator

Other:

Please share your primary practice setting.

Public Health

Hospital

Critical Access Hospital

Emergency Department

Urgent Care Clinic

Federally Qualified Health Center

Rural Health Clinic

Primary Care Clinic

Community-Based Mental Health Clinic

K-12 School

College or University

Other:

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Mailing address for your practice location *

What toolkit(s) would you like to access? *

ADHD Toolkit

Autism Toolkit

Mental Health Toolkit

Bright Futures Toolkit (includes information on universal screening for mental health)

Would you like to receive additional information on future opportunities and resources? (Choose all that apply) *

Yes, I would like to receive the quarterly Maternal and Child Health digital newsletter

Yes, I would like to receive the Pediatric Mental Health Care Access digital newsletter

Yes, I would like to receive the twice-monthly Office of Rural Health digital newsletter

Required

Send me a copy of my responses.

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