Stroke Certification Application

Facility Name*

Mailing Address*

City*

State/Emirate/Other*

Region*

Website URL*

Primary Contact First Name*

Primary Contact Last Name*

Primary Contact Job Title*

Phone*

Email*

Please select which certification program your facility is applying for*

Acute Stroke Ready*

Primary Stroke Center

Comprehensive Stroke Center

Site Details

Does your site use an electronic health record (EHR)?*

Yes

No

Are you using a data registry?*

*Only available in the UAE.

As a part of certification, I authorize the regional Association staff experts to participate in the certification process and attend the reviews as silent observers.