Rural Hospital Partnership Landing Page Questionnaire
This questionnaire is required to complete your Partner Landing Page. Responses should reflect rural healthcare challenges, solutions, and outcomes discussed during your kickoff call and the TRUSTED Messaging Framework exercise. Please submit this form within 7 days of your kickoff call to ensure timely participation in partnership activities.
Organization name
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Name of person completing form
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First Name
Last Name
Email
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example@example.com
Main point of contact (POC) and subject matter expert (SME) that will represent the organization and be able to answer questions (if you have more than one POC/SME please include their information and service line in the additional information field below).
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First Name
Last Name
POC/SME title
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POC/SME phone number (do not use a main line, must be a number to reach the POC/SME)
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-
Area Code
Phone Number
POC/SME email (do not use a generic or information email, must be a email to reach the POC/SME)
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Upload logo (300x300 pixels)
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Provide a RURAL SPECIFIC URL for your landing page
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Brief summary of your mission or impact in rural healthcare. Short, clear, meaningful.
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(Example: We strengthen rural hospital operations through scalable clinical support and cost-effective technology designed for low-volume facilities).
3–5 keywords that describe your rural healthcare focus.
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(Examples: rural workforce, financial stability, access to care)
Describe the core services or solutions you provide to rural hospitals and clinics.
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What rural healthcare challenges do your solutions address?
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(Examples: limited staffing, reimbursement pressure, gaps in specialty care)
How your solutions are designed or structured for rural healthcare?
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(Example: Affordable, scalable, and designed for small rural facilities)
Provide one or two measurable results that show your rural impact.
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(Examples: reduced readmissions by 12 percent, increased reimbursements by 18 percent)
Share a rural success story that illustrates your impact.
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(Example: Partnered with [Hospital Name] to implement [Solution], leading to[specific outcome])
Provide client testimonial (s) focused on rural healthcare.
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What makes your organization uniquely committed to rural hospitals and clinics.
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(Examples: years of rural experience, small facility expertise, frontier knowledge)
Organizations LinkedIn
optional
Organizations Instagram
optional
Organizations X
optional
Organizations Facebook
optional
Video (YouTube or Vimeo Link)
optional
Video (YouTube or Vimeo Link)
optional
Video (YouTube or Vimeo Link)
optional
Video (YouTube or Vimeo Link)
optional
Upload additional images (best practices include a picture of your team and/or a picture of your product or service being used)
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Optional
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Which service category do you want to be listed under?
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Accreditation
Finance/Rev Cycle/Consulting/Audit
Construction/Design/Planning/Marketing
Staffing/Workforce/Residency/Management/Development
Technology/Telehealth/Patient Monitoring/Imaging
Transitional Care/Wound Care/Lab/Pharmacy
GPO/Insurance/ACO
Nonprofit/Not for Profit/Co Op/Government
Additional information
Please include any additional POC information here or any other additional information you would like considered for publication.
Submit
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