MYHEALTH (http://healthonthemove.net/) is a EU funded project which aims to improve the healthcare access of vulnerable immigrants and refugees by developing and implementing models based on the knowhow of a European multidisciplinary network.

The main outcome will be an interactive map (and database) available on the website with key referent sites (refugee camps, NGOs offices, community healthcare departments, etc) that provide support to migrants and refugees.
In order to accomplish that we ask you to fill in all the information requested.

 

Read all the information requested and collect them before answering.
Response options could be:
- multiple choice/single answer: you need to check only one answer (circle)
- multiple choice/multiple answers: you can check one or more than one answer (square)
- text -> you have to write what requested
Fields with an asterisk are mandatory.

With the same link you can fill more than one form.

By pressing < DONE > at the end of this form you accept that data you provide will be treated in relation at the aims of MYHEALTH project.




If you have any trouble or question write to giovanni.ragazzi@regione.emilia-romagna.it




Your email address

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* 1. Your email address

Name of the Organisation/Service

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* 2. Name of the Organisation/Service

Type of Organisation/Service

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* 3. Type of Organisation/Service

Brief description (max 144 characters) of the Organisation/Service
This description will be immediately visible on the interactive map. In order to be effective and to best promote the organisation/service try to be clear, short, simple, like in a tweet.
This question requires at least 1 answer

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* 4. Brief description (max 144 characters) of the Organisation/Service
This description will be immediately visible on the interactive map. In order to be effective and to best promote the organisation/service try to be clear, short, simple, like in a tweet.
This question requires at least 1 answer

Primary country of the Organisation/Service
In which country(-ies) is the Organisation/Service located and active?

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* 5. Primary country of the Organisation/Service
In which country(-ies) is the Organisation/Service located and active?

The primary target(s) of the Organisation/Service's activities is/are...

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* 6. The primary target(s) of the Organisation/Service's activities is/are...

If applicable: The activities of the Organisation/Service are directed to (gender)...

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* 7. If applicable: The activities of the Organisation/Service are directed to (gender)...

If applicable: The activities of the Organisation/Service are directed to (legally adults/minors)...

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* 8. If applicable: The activities of the Organisation/Service are directed to (legally adults/minors)...

Main activities of the Organisation/Service (please check max 3 answers) are...

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* 9. Main activities of the Organisation/Service (please check max 3 answers) are...

Are there any specific requirements to access?

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* 10. Are there any specific requirements to access?

If yes, please list the specific requirements

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* 11. If yes, please list the specific requirements

Cost

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* 12. Cost

Spoken languages
Which language(s) is/are used in the Organisation/Service?

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* 13. Spoken languages
Which language(s) is/are used in the Organisation/Service?

Head office address and contact information

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* 14. Head office address and contact information

Additional contact information

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* 15. Additional contact information

Website
Copy and paste the web address of the Organisation/Service

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* 16. Website
Copy and paste the web address of the Organisation/Service

Opening hours

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* 17. Opening hours

Do you know about other Organisation/Service that may be relevant for the purpose of MYHEALTH project?

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* 18. Do you know about other Organisation/Service that may be relevant for the purpose of MYHEALTH project?

If yes, please provide other Organisation/Service contact information

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* 19. If yes, please provide other Organisation/Service contact information

If you have any comment or question please feel free to write to giovanni.ragazzi@regione.emilia-romagna.it or share your thoughts/suggestions in the space below.

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* 20. If you have any comment or question please feel free to write to giovanni.ragazzi@regione.emilia-romagna.it or share your thoughts/suggestions in the space below.

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