This form is to be completed by the person who is requesting access to Saint Elizabeth Health Care's technology application, @YourSide Colleague®. Items marked with a red asterisk (*) are required.

I understand that the personal information I am submitting is being collected by Saint Elizabeth Health Care for the purpose of creating an access account on @YourSide Colleague®. Any information that I provide will be kept private and confidential by Saint Elizabeth Health Care, and will not be disclosed or sold to any third party.

I understand that I have a responsibility to maintain security, and client and organizational confidentiality. I also understand that Saint Elizabeth Health Care is the sole owner of the @YourSide Colleague® technology. The login and password of my account is restricted, and is to be used for my own professional use, and is not transferable to anyone. I will not disclose the details of my account to anyone, nor will I allow my account to be used by anyone other than the person named in this confidentiality agreement.

If you understand and agree to the terms of this confidentiality agreement, please click on the I AGREE button.