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Please completeand return via:
(877) 250-2559Local (916) 200-3886
Planning WorksheetQuestions? Call Don McCormick at (877) 646-5877 x 200 (9am-5pm PST)
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
e Contact Information:Your Name _______________________ Title _________________ Department ____________________________________________
Organization ___________________________________________
Address _______________________________________________ City _____________________ State _________ Zip ____________
Phone ( ) _________________ Fax ( ) __________________
Email _________________________________________________
q Topper Details:
UNIT NAME/LOCATION:
May we have permission to email or fax you about special savings or new product introductions?
To correctly manufacture your Toppers, we need exact measurements. Measure the EXACT height and width of the INSIDE of your cur-rent Patient Care Board(s).
w Stakeholders: How many individuals (including yourself) will be involved in the review and approval process?________________
Will your marketing or public relations department be involved in the review process? � Yes � No
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Y N
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
Does this Topper need a pre-printed:?
�Room# �Room Phone# �Neither
Build-a-Board Design Tool Filename:
Does this Topper need a 2nd language?�Y �NIf yes, language:
Orientation:
UNIT NAME/LOCATION:
Quantity:
INNER WIDTH:
________ “H
WINNER HEIGHT :
________ “
Portrait Landscape� �
REFERENCES:1 Robert Wood Johnson Foundation “Improving Patient-Staff Communication Through White Boards.”
Voice Toll Free (877) 646-5877Email [email protected]
Web HealthcareInspirations.comMail 4225 Northgate Blvd. Suite 4 • Sacramento CA 95834
Since implementing white boards, Press Ganey scores im-
proved 2.5 points, resulting in a 5% increase in overall in-
stitution satisfaction.13
DIRECTOR, SERVICE EXCELLENCENORTH SHORE-LONG ISLAND JEWISH HOSPITAL
One of our key drivers as a hospital is to keep patients in-
formed. Implementing white boards as a communications
tool has put our nurses closer to the bedside and improved
information shared between our patients and their care
team. Using white boards has turned into a best practice.1
NURSE MANAGER
NORTH SHORE-LONG ISLAND JEWISH HOSPITAL
We are proud to be a Nurse and Veteran-owned business.