Welcome to WomenHeart! Please read the brief descriptions below to determine which form or forms you need to fill out.
HeartScarves: use this form if you have participated in one or more of the following:
- Set up, coordinated and or communicated with local craft groups (i.e. knitting, crocheting, weaving, etc.) regarding participation in the HeartScarves Program
- Picked up and/or dropped off scarves
- Created or prepared scarves for distribution (including sewing tags, writing note cards, sterilizing, and packaging scarves, etc.
WomenHeart Promotional Activities: use this form if you have participated in one or more of the following:
- Visited a cardiologist, cardiac rehab nurse, or other personnel at a doctor's office, hospital, or other medical facility as a representative of WomenHeart
- Dropped supplies or materials off at a doctor's office, hospital, or medical facility
- Participated in networking meetings, or activities with representatives of organizations, medical facilities, or other entities interested in partnering or supporting WomenHeart
One-on-One Support: use this form to document all activity and correspondence with women in which you have offered individualized support in one or more of the following ways:
- Phone support
- Online support via email, Skype, chat, or any other online group platform
- In-person support including personal meetings with women in need and/or visits with patients at a hospital, rehab facility, or other venue
- Written letters or other correspondence
This form does not include support given to Support Network members during or regarding Support Network meetings or activities.
Community Education Outreach: use this form if you have participated in one or more of the following educational outreach activities.
- Health Fairs or Expos
- Speaking Engagements
- Panel Discussions
- Media interviews and/or activities
Support Network Coordinator Report: use this form to document all support network activities, support network meetings, and time dedicated to managing your support network. This form should only be submitted by Support Network Coordinators and/or Co-coordinators.