3Greens New Pilot Info Request Form and Application

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1. Your Contact Info (Required.)

First Name

Last Name

Degree (MD, DO, RN, etc)

mobile #

City, State

Employer

Primary Hospital

Specialty

Which medical/surgical societies are you a member? (SRS, etc)

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2. What interests you about 3Greens? (Required.)

Preop Checklists

Preop Conferencing / Team Review

Intra-Op Checklists

Postop Checklists

Timer / Efficiency Tracking

Teamwork Enhancement

Operating room Flow Analysis

Personal Registry Data Collection

Registry Data Collection for National Registries

Burnout prevention / work-life balance

Improving Clinic Efficiency and Flow

Analytics / Dashboards

Other (please specify)

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3. Number of years in practice

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4. Who referred you to 3Greens? Current Pilot? (Required.)

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5. Tell us a little about your journey thus far, and how you might be able to be valuable member of an upcoming 3Greens squadron.

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6. What times are usually good for you for Webinar / Zoom Call?

Sun Afternoon

Sun Eve

Mon Eve

Wed Eve

Thu Eve

Saturday AM

Saturday Afternoon

Thank you for sending your request. We will be back in touch shortly. The 3Greens Flight Support Team. support@3Greens.com, or Lloyd.Hey@3Greens.com

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* 1. Your Contact Info (Required.)

Question Title

* 2. What interests you about 3Greens? (Required.)

Question Title

* 3. Number of years in practice

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* 4. Who referred you to 3Greens? Current Pilot? (Required.)

Question Title

* 5. Tell us a little about your journey thus far, and how you might be able to be valuable member of an upcoming 3Greens squadron.

Question Title

* 6. What times are usually good for you for Webinar / Zoom Call?

1. Your Contact Info (Required.)

2. What interests you about 3Greens? (Required.)

3. Number of years in practice

4. Who referred you to 3Greens? Current Pilot? (Required.)

5. Tell us a little about your journey thus far, and how you might be able to be valuable member of an upcoming 3Greens squadron.

6. What times are usually good for you for Webinar / Zoom Call?