Color Site Registration & Custom Content Form

Color Site Registration Form

Color is excited to be partnering with you to expand access to vaccines for your population. Our goal is to provide a program that meets your needs while simultaneously providing you with a high level overview of the process from now until your program launches. In this partnership, Color will prioritize your experience and support you in each step of creating a seamless vaccination site system for your participants. Strong ongoing communication will be critical to the success of this program.
Before submitting your onboarding form, please confirm you have signed and returned your Site Agreement with Massachusetts Department of Public Health (MDPH)
Population point of contact

The population POC will be the main point of contact for your vaccination program and will be the contact for our Site Support team.
Full Name
First Name, Last Name
Title
Email
This email will be used as the contact for our Support team
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization Information
Organization/Display Name
Population Name
Please copy and paste the population name you received in your onboarding confirmation email from MDPH
MIIS provider PIN
Will you be using ForHealth (Commonwealth Medicine/UMass Chan) for insurance billing/reimbursement?
Participant support

Color is operating a patient support call center / inbox for technical questions about scheduling and other customer support questions. For site-specific information (e.g., accessibility, directions) we need to gather some information so we can coordinate with your organization's resources to properly triage questions from patients visiting your site.
Support phone number
Please enter a valid phone number.Format: (000) 000-0000.
Support days of operation
Support hours of operation
Support email address
example@example.com
Question types handled
Other information you'd like to share
Vaccination site

Please provide the details for a single vaccination site. Once you gain access to Color, you will be able to create additional sites following these steps: https://docs.color.com/docs/create-new-site
Name of location
Address - Line 1

Street Address - Line 1

Street Address Line 2

City

Zip Code
Address - Line 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Specific room number or space (optional)
Any directions needed for parking or finding the location
Onsite contact name
Onsite contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
Onsite contact email
example@example.com
Site Manager email(s) (this designated staff person can add/remove staff permissions at your clinic site/s and is generally the lead administrator planning clinics)
Access management email(s) (this designated staff person can add/remove staff access to your Dashboards (reporting data) at your clinic site/s)
Free accessibility services available onsite (optional) This is where you may list any accessibility services such as wheelchair accessible etc
Are you onboarding as a Mpox provider?
Vaccines you will be offering at your clinic (please select all that apply)
Display name (site vendor-specific)
What you can expect next
You will receive an email from Color when your site is fully configured and ready for launch! We look forward to partnering with you to expand access to vaccines for your population.
Should be Empty:

Color Site Registration Form

Population point of contact

Organization Information

Participant support

Vaccination site

What you can expect next