REACH Telehealth Forms

CDD REACH Telehealth Request Form

Please complete and return to REACHCDD@salud.unm.edu or fax to: 505-272-5883. Click on the boxes to make a selection. Please note that there is a place for additional information on the second page.

For Room Only Scheduling

If you would like to schedule room 115 or room 411 at the CDD, but not for a telehealth event, please complete the REACH Telehealth Request Form and check “CDD Room only” as the Conference Type. Also, please indicate the number of people you are expecting and any items under Presentation Type that apply. Please remember that food is not allowed in the telehealth rooms.

Seminar/Training Data Sheet

One of these forms is completed for each training event, usually by the person who made the request.

Clinical Consult Data Sheet

One of these forms is completed for each consultation.

CDD REACH SignIn Sheet

Please have each participant print their name clearly. This becomes especially important for individuals who are requesting CMEs or CEUs.

Post-Teleconference Survey Forms:

Clinical Consult/Case Consult – Consultant Survey Form
Consult - Family Survey Form
Training/Case Consult - Participant Survey Form
Training - Trainer Survey Form