Request Tools in Other Language
Please fill out this form to request translated tool(s) for individual, non-commercial purposes only, including caregiving for family members and personal learning. It is not meant for distribution or use in any professional group or organizational setting.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your role in palliative care?
*
Which tool(s) are you requesting to use?
*
Palliative Performance Scale (PPSv2)
Bereavement Risk Assessment Tool (BRAT)
Bowel Performance Scale
Respiratory Congestion Scale
Psychosocial Assessment Tool
10 Steps for Better Prognostication
Would you be using the tool(s) for profit?
*
Yes (add details below)
No
Please provide more information about how you will use the tool(s)
*
In which language do you want to translate the tool(s) in?
*
Back
Next
Please review and check each clause to confirm your agreement with the copyright permission terms:
*
Permission is granted for non-exclusive rights to publish the tool(s) in the requested language only.
A credit line will appear at the bottom of the tool(s) and will include Copyright Victoria Hospice Society, BC, Canada www.victoriahospice.org, along with credits to the translator for unofficial translation.
No modifications to the content, structure and meaning of the tool(s) is allowed.
The tool(s) must be used with complete usage instructions, including the chart, instructions for use and definition of terms.
The tool(s) must not be used in any way that generates profit from the tool(s) itself, including resale, licensing, or commercial distribution.
Permission is granted solely for the translation of the tool(s). Any use of the tool(s) for any other purpose requires a separate application and permission letter.
Submit
Should be Empty: