ValleySim Hospital Interest form - Catawba Valley Community College

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ValleySim Hospital
ValleySim Hospital Interest form

Required Fields *

Thank you for your interest in ValleySim Hospital. Please complete the form below to give us more information about your needs and a member of our team will reach out to you. If you have any questions please contact us at 828-327-7000, ext. 4072.

First Name*

Last Name*

Organization-Company:

Department/Facility:

Email Address*

Phone Number:

Type of Participants:

(i.e. Healthcare Learners, Emergency Management, Marketing, Film Production):

Estimated Number of Participants:

Please give a brief description of your proposed simulation education or event.

Please select areas of interest for your simulation or event.

For more information on available rooms, please click here.

Areas of interest:

Acute Care (Eleven Patient Rooms and Nurses’ Station)

ICU #1/ ICU #2 and/or Surgical Suite

Women and Children’s Health (NICU/Nursery/Labor & Delivery and Nurses’ Station)

Debrief Room (seating up 24)

Auditorium (seating up 75)

If interested in using simulation equipment for your session please make a selection of High Fidelity Manikins and/or Task Trainers needed.

For more information on available equipment, please click here.

Task Trainers:

Airway

Arterial/IV Access

Trauma

Other

If other, please specify

Please select your top 3 date and time choices:

First Choice

Second Choice

Third Choice

Please note: your registration is not complete until you have received an email confirmation of your request. A member of our team will reach out to discuss availability.
*Form must include First Name, Last Name, and Email Address.