Get Samples Please complete the form below and select the samples you would like to get. After you submit the form, you will receive an email with the samples attached in PDF files. We respect your desire for privacy and will not share your e-mail address or information with third parties. You will need the Adobe Reader to open the order forms. If you do not have this application, you can get it free (and safely) by clicking on this link: www.get.adobe.com/reader. Use the print option on the File menu to print the form Organization Name* First Name * Last Name * Email * Phone * Contact Role ---3rd PartyAccounts ReceivableAuthorizerClinicalDecision MakerDirectorHelp DeskInfluencerInquirerOffice ManagerOffice StaffOtherPrimaryPrimary AccountingQualityReceptionistReferenceSalesTechnicalUserVendor Other How do you want us to contact you? * EmailTelephone Are you going to do a research study? * YesNo Are you a student? * YesNo What is your annual census (the number of patients/clients per year that you serve)? * ---Up to 200 patients/clients per year201-400 patients/clients per year401-600 patients/clients per year601-800 patients/clients per year801-1000 patients/clients per year1001-1200 patients/clients per year1200+ patients/clients per year Please specify your Census, if over 1200*: How many full-time equivalent (FTE) clinicians do you intend to license? * ---1 Clinician only2-5 Clinicians6-10 Clinicians11-15 Clinicians16-50 Clinicians51+ Clinicians at 1 facility51+ Clinicians at multiple facilities in 1 state or province51+ Clinicians in multiple states or provinces51+ Clinicians in multiple countries Are you/your organization utilizing an EHR/EMR system? If, yes, please include EHR/EMR system/company that you are utilizing? Please select all the settings of care that apply to your organization * Alcohol and Drug Rehabilitation FacilityBehavioral Health AgencyCommunity Mental Health CenterCorrectionalCounseling CenterDay TreatmentEAP ServicesEMR/EHR CompanyFFTGovernment Mental / Behavioral Health (national, state, county or city level)Healthcare CompanyHorse/Equine TherapyHospitalInsurance/Managed Care ProviderInternationalIOP (Outpatient Program)IP (Inpatient)Juvenile JusticeMilitary (Active Duty)Nonprofit AgencyNursing HomeOtherOutpatientPrivate or Solo PractitionerPsychiatric HospitalResidential Treatment CenterSchoolSmall Group PracticeStudentTelemental Health ServicesUniversityUniversity/College Counseling CenterUniversity/College Training ClinicVA CenterVendorVeteransWilderness or Adventure TherapyNon-profit Agency Other How did you hear about us? (Check all that apply.) * AGPAAPTCArticleColleagueConferenceCurrently useEAGALAEmail InquiryFacebookFFTGary BurlingameJoint CommissionLinkedinMike LambertNATSAPOtherPhone InquiryPreviously usedReferralResearch Project/ArticleSearch EngineTraining ClinicTwitterYouTubeWord Of Mouth Name of Colleague Name of Conference Specify Company or University Name of Facebook Group Other Specify Company or University Referral Word of Mouth Instruments Select the samples you would like to get. Adult Measures: OQ®-45.2OQ® TA (Therapeutic Alliance)OQ®-30.2OQ®-ASCS-OQ® 2.0OQ®-10.2BPRS Youth/Adolescent Measures: Y-OQ® 2.01Y-OQ® SR 2.0Y-OQ® 30.2 SRY-OQ® TSM ParentY-OQ® TSM YouthY-OQ® PR TA (Therapeutic Alliance)Y-OQ® SR TA (Therapeutic Alliance) Group Measures: OQ®-GRQOQ®-GQGCQ-S Military Measures: OQ®-WRAP Which format are you interested in? * OQ®-Analyst SoftwareOQ®-PaperOQ®-Access Yes, I'd like to receive relevant news from OQ Measures. I can sign off easily at any given time. Your Comments/Questions