Wound Care Clinic Directory Inclusion Form

The
purpose of the wound care clinic directory is to help patients and caregivers
locate sources for wound care and management. It also provides a networking
guide for patients, caregivers and wound care professionals. To include
your listing in this annually published directory, please fill out the
below information. There is currently no charge for this service.

Please note that the hard copy form of this directory is compiled annually
and is available to AAWC Members free of charge. The directory is also
available on CD ROM. Members may purchase the CD ROM, and non-AAWC members
may purchase the hardcopy and/or CD ROM while supplies last. Click
here
for an Order Form.

Please provide the following clinic/wound care center information:

Clinic Name
Director/Manager
Affiliation/Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
Clinic URL if Available

Select any of the following options that apply:


We offer Management/Counseling Services

We offer Products and Other Services

Choose one of the following options:


I am authorized to submit and allow this information to be published

I am not authorized to submit this information for publication

Comments:

Enter the date of this submission:


mm/dd/yy