Request a Quote

I'm an educator or administrator and I am interested in the following subscription-based courses:*
Aquifer’s existing interdisciplinary cases (Trauma-Informed Care, Excellence in Palliative Care, Diagnostic Excellence, High Value Care, Social Determinants of Health) will be updated and redesigned, and new cases will be added to form the Clinical Excellence Case Sets. 52 new or optimized interdisciplinary cases will be included in the Clinical Excellence Case Sets, which will be available on July 1 by subscription for the price of one Aquifer course.
- Aquifer Family Medicine
- Aquifer Geriatrics
- Aquifer Internal Medicine
- Aquifer Pediatrics
- Aquifer Radiology
- Aquifer Neurology (Available July 1, 2023)
- Aquifer Clinical Excellence (Available July 1, 2023)
- WISE-MD (Surgery)
- WISE-OnCall (Readiness for Practice)
- CARE (Course on Addiction Recovery & Education), formerly Aquifer Addiction
I am:*
- New to Aquifer.
- Looking to add additional courses to my current subscription.
Name*
First Last
Email*
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Phone*
My Role/Title at my institution:*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I'm affiliated with the following program:*
Institutional subscriptions are applicable to a single program at your institution. Institutional subscriptions may not be shared across separately accredited programs at your institution.
Program Name:
I am affiliated with a:*
- U.S. Allopathic Medical School
- U.S. Osteopathic Medical School
- U.S. Physician Assistant Program
- U.S. Nurse Practitioner Program
- U.S. Other Nursing Program
- Other U.S. Program
- International Program
- Residency/Fellowship Program
The total annual enrollment in my program is:*
Date when I would like to begin my subscription:*
(ie. ASAP, July 1 2020, next year, not sure). This will help us prioritize quote requests.
Total Program Enrollment*
My program's total program enrollment is:
- 1-199
- 200-299
- 300-399
- 400-499
- 500-599
- 600-699
- 700-799
- 800+
Billing Contact
This person will only be contacted if your program decides to purchase an Aquifer subscription.
Billing Contact Name
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Same as Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Email*
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First Name*

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Email*

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School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

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Pricing information

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First Name*

Last Name*

Email*

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Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Name

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"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Comments

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"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Name

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Phone

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Name

This field is for validation purposes and should be left unchanged.

For Educators & Administrators

Billing Contact

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