A project of the U.S. Department of Health and Human Services Office on Women's Health

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Resource suggestion form

We're always looking for new resources to link to from trustworthy organizations. We have selection criteria in place to make sure the organizations we link to and the resources they provide are credible and reliable. If you think your organization meets our standards, we invite you to fill out our organization interview form.

Please review our resource selection criteria before you submit your organization for consideration.

View our privacy policy. | * = Required fields.

About your organization

Organization name *
Parent organization(s) (optional) List from the largest to smallest entity	Acronym(s) (optional) List from the largest to smallest entity
Mission statement * (500 character limit)

Your organization's contact information

Street address *	Street address (line 2) (optional)
City *	State *	Zip code *
Email address (optional) For public inquiries	URL (optional) The web address appears in the address bar at the top of your web browser and begins with 'http://'.
Main phone *	Toll-free phone (optional)
TTY/TDD (optional) Phone number for telecommunication devices for the deaf or hearing impaired	Fax (optional)
Will you accept phone referrals to your organization by womenshealth.gov? * Yes No
Languages you can respond to phone calls in: Select all that apply

Your organization's publications

Do you offer free women's health publications, such as printed pamphlets or brochures, to patients and the general public? * Yes No
Will you accept orders for health publications from womenshealth.gov on behalf of a private citizen? * Yes No

If you answered yes to the last two questions, please complete the following questions. If you answered no to either question, skip to the Your contact information section.

Publication requests are accepted via:

Email address

Fax

May we provide this email address to the public?
Yes No

May we provide this fax number to the public?
Yes No

Does your publication fulfillment department or clearinghouse have different contact information from that listed in the Your organization's contact information section (above)?
Yes No

If you answered yes to the last question, please complete the following questions. If you answered no, skip to the Your contact information section.

Fulfillment department or clearinghouse information
Street address	Street address (line 2)
City	State	Zip code

Your contact information

If we have any questions about your application, we'll contact you using this information. This information will not be publicly displayed.

First name *	Last name *
Email address *	Phone number *	Phone extension

Additional comments (500 character limit)

I have read and understood the resource selection criteria and I believe my organization qualifies for inclusion on womenshealth.gov.

Please note

Unless otherwise noted, all information provided in this form may be displayed publically.
We routinely experience an overwhelming volume of email. Please allow five to 10 business days for a response. If this is an urgent health question, please contact your health care provider. If this is an emergency, please call 911.

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Content last updated February 17, 2013.

womenshealth.gov
A federal government website managed by the Office on Women's Health in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services.
200 Independence Avenue, S.W. • Washington, DC 20201

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