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MPV (Monkeypox)
- Info & Resources
COVID-19
- Services & Resources
Services
- Full-Spectrum Care
- Additional Services
Education & Training
- Resources & Education
- Professional Training
  - AIDS Education & Training Center
Get Involved
- Ways to Support PHNTX
About
- Who We Are
  - About PHNTX
  - Locations
  - News
  - Careers
  - Contact Us

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Group of Providers and Staff

SCAETC Service Request Form

Step 1 of 5

20%

What service(s) does your practice need?*
Select all that applies.
- Education (trainings, workshops, clinical & behavioral health preceptorships)
- Clinical Case Consultations & Communities of Practice (provider to provider)
- Technical Assistance & Practice Transformation

Education - Trainings, Workshops, Clinical & Behavioral Health Preceptorships
Which primary audiences require the training/education?
What is the training topic needed for the requested education?
What is your preferred training modality?
- Webinar
- Face-to-Face
- On Demand

Clinical Case Consultations & Communities of Practice - Provider to Provider
What is the topic of interest for the requested cast consultation/CoP?

Technical Assistance & Practice Transformation
What is the topic of interest for the requested for the Technical Assistance or Practice Transformation?

Name*
First Last
Your title or role at your organization*
Email*
Phone*
Your preferred method of contact*
- Email
- Phone
- Either is okay.
Please provide 2-3 dates and times that you are available to discuss the request*
Our office will follow up with a call or email to schedule the meeting.
Date Time
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New Patient Appointment Inquiry

If you are a current patient of Prism Health North Texas, please use the Patient Portal to request an appointment. Clinic business hours are Monday-Friday from 8 am to 5 pm. If you submit an appointment request outside clinic hours or on weekends, we will reach out to you during the next business day.

First Name*
Last Name*
Phone*
Service*
(Select all that apply)
- HIV Primary Care
- STI Testing/Treatment
- Case Management
- PrEP
- Transgender Care
Preferred Availability*
(Select all that apply)
- Monday Morning
- Tuesday Morning
- Wednesday Morning
- Thursday Morning
- Friday Morning
- Monday Afternoon
- Tuesday Afternoon
- Wednesday Afternoon
- Thursday Afternoon
- Friday Afternoon
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