Eligibility review

Request a No Cost Noise Assessment

Tell us about your hospital campus, proposed inpatient units, and preferred timing. MindWave will review the request and contact you to arrange a scheduling call.

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Step 1 of 5

Hospital campus

The campus must be a Joint Commission-accredited inpatient hospital in the continental United States with more than 50 inpatient beds.

Hospital name

Campus name

Street address

City

State

ZIP code

Inpatient bed count

Step 2 of 5

Requestor

Who should MindWave contact about this request?

First name

Last name

Role or title

Work email

Phone

Step 3 of 5

Administrative contact

MindWave will work with you and your listed administrative contact to arrange the assessment.

Same as Requestor

First name

Last name

Title

Work email

Phone

Step 4 of 5

Proposed inpatient units

Add one to four inpatient units. If one unit is not eligible, you can replace that unit without restarting the request.

Unit 1

Unit name

Unit type

This unit appears to be an emergency, behavioral health, outpatient, or procedural area. Please replace it with an eligible inpatient unit.

Unit 2

Remove

Unit name

Unit type

This unit appears to be an emergency, behavioral health, outpatient, or procedural area. Please replace it with an eligible inpatient unit.

Unit 3

Remove

Unit name

Unit type

This unit appears to be an emergency, behavioral health, outpatient, or procedural area. Please replace it with an eligible inpatient unit.

Unit 4

Remove

Unit name

Unit type

This unit appears to be an emergency, behavioral health, outpatient, or procedural area. Please replace it with an eligible inpatient unit.

+ Add another unit

Step 5 of 5

Preferred timing

Share three preferred date ranges. Final timing will be coordinated by phone after review and will account for travel logistics.

First preference

Start

End

Second preference

Start

End

Third preference

Start

End

Blackout dates

Scheduling or facility notes

Scope-AcknowledgementI understand this is a non-regulatory noise assessment, not an accreditation, compliance, occupational-safety, or regulatory certification.

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MindWave’s no-cost audio assessment is subject to capacity limits. Submission does not guarantee scheduling.

Your request appears eligible.

MindWave will review your preferred dates and contact you to arrange a scheduling call. We will work with you to coordinate facility requirements as necessary. We look forward to speaking soon.

We could not submit your request. Please review the form and try again, or contact MindWave Medical directly.