UCLA Health, International Services | Potential Partner Survey

UCLA Health International Services

Partner Inquiry Form

Please fill out the following survey to submit your interest, as an organization, in partnering with UCLA Health International Services. Thank you.

Please note that any field marked with * is a required field

Company Name*
Preferred in English

Company Main Phone Number

Company Main Email Address

Company Website

What country are you based in?*

What category of UCLA Health services would be most relevant to your needs? Check all that apply.*

Patient Services (i.e., In-person Patient Referrals, Second Opinion Teleconsultations, Written Second Opinions, etc.)
Consulting/Management (i.e., Hospital Development, Service Line Development, etc.)
Research (i.e. Clinical Research, Joint Research Collaborations, etc.)
Education (i.e., Medical Education and Training, Distance Learning, Physician or Nursing Observerships, Tailored Education Programs, etc.)
Marketing (i.e., Co-Marketing Activities, Publications, etc.)