Submit a Shining Moment

Superior Health Quality Alliance wants to celebrate individuals and organizations by highlighting and sharing moments of success, dedication, innovation, resiliency and more! Take a minute to share and acknowledge a Shining Moment. We will work to collect these shining moments and share these stories in future communications.

"Coming together is a beginning; keeping together is progress; working together is success." — Edward Everett Hale

1. Your Name: *This question is required.

2. Your Organization: *This question is required.

3. Your Email Address: *This question is required. This email will be used to by our staff if additional information is needed.

4. Phone Number:

5. Name or Organization you would like to acknowledge and celebrate: *This question is required.

6. Share a Shining Moment: *This question is required.

7.

I hereby grant permission to Superior Health Quality Alliance to disclose our relationship with them in quality improvement projects and to use and/or publish information regarding our organization’s quality improvement efforts, including interventions, literature, documents, images, graphs, or other materials for the purpose of furthering the advancement of health care quality. This is to include print, electronic, visual, verbal, web and/or various media for indefinite period of time. This release and consent is made without compensation and none is required or anticipated. You may revoke the authorization in writing fax to (608) 274-5008 or to Communications Director, Superior Health Quality Alliance, 2909 Landmark Place, Madison, WI 53713, or email: info@superiorhealthqa.org.

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