Urgent Care Triage Info Request Please complete this form and click submit. We will respond in the order received. Thank you. Name* First Last Work Email* Note: We ONLY respond to work related email addresses.Facility Name & City*Work Phone*Triage First responds ONLY to facility/department phone numbers.Enter phone extension number (if applicable)What best describes your position?*ManagementSupervisoryEducationalWhat triage acuity scale is currently in use in your Urgent Care?*Canadian Triage Acuity Scale (CTAS)Emergency Severity Index (ESI)Three Level AcuityFour Level AcuityUnknownHow many Urgent Care centers are in your system?* 1-3 4-5 6-10 More than 11 Is there anything you would like to add?