{"id":855,"date":"2025-10-01T21:56:04","date_gmt":"2025-10-01T21:56:04","guid":{"rendered":"https:\/\/www2025.patienttools.com\/?page_id=855"},"modified":"2025-10-23T19:59:29","modified_gmt":"2025-10-23T19:59:29","slug":"sign-up-pro","status":"publish","type":"page","link":"https:\/\/www.patienttools.com\/index.php\/pricing\/sign-up-pro\/","title":{"rendered":"Sign Up Pro"},"content":{"rendered":"\n<section class=\"gbp-section has-gradient-bg gb-element-b2b3b9a5\">\n<div class=\"gb-element-2582588b\">\n<h1 class=\"gb-text gbp-section__headline gb-text-2d6cfbeb\">Sign Up Pro<\/h1>\n\n\n\n<form action=\"https:\/\/portal.patienttools.com\/subscribe\/postdata\/\" method=\"post\" id=\"signupForm\"><center>\n   <table id=\"HIW\" style=\"margin:0px 0px 0px 0px;color:black;background-color:#e8f5e8;border:0px;\">\n        <!--Section 1-->\n        <tr>\n            <td style=\"padding-left:20px;border:0px;\">\n                \n                    <div class=\"row\" style=\"font-size:15px;width:100%;padding:5px;color:black;border:0px;\">*required items<\/div>\n                    <div class=\"row\" style=\"font-size:15px;width:100%;color:black;border:0px;\">&nbsp;<\/div>\n                    <div class=\"row\">\n                        <div class=\"column\" style=\"width:100%;\">\n                            <div class=\"row\" style=\"width:100%;padding:0px 5px;float:left;margin:0px 5px;border:0px;\">\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding-right:5px;font-size:17px;border:0px;\">\n                                    <label>\n                                        Account First Name*<br>\n                                        <input type=\"text\" name=\"firstName\" id=\"firstName\" value=\"\" size=\"40\" required style=\"margin:5px 0px;font-weight:normal;border:1px;border-radius:5px;\">\n                                    <\/label>\n                                <\/div>\n                            <\/div>\n                            <div class=\"row\" style=\"width:100%;padding:0px 5px;float:left;margin:0px 5px;\">\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding-right:5px;font-size:17px;border:0px;\">\n                                    <label>\n                                        Account Last Name*<br>\n                                        <input type=\"text\" name=\"lastName\" id=\"lastName\" value=\"\" size=\"40\" required style=\"margin:5px 0px;font-weight:normal;border:1px;border-radius:5px;\">\n                                    <\/label>\n                                <\/div>\n                            <\/div>\n                            <div class=\"row\" style=\"width:100%;padding:0px 5px;float:left;margin:0px 5px;\">\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding-right:5px;font-size:17px;\">\n                                    <label>\n                                        Account Email*<br>\n                                        <input type=\"text\" name=\"email\" id=\"email\" value=\"\" size=\"40\" required style=\"margin:5px 0px;font-weight:normal;border:1px;border-radius:5px;\">\n                                    <\/label>\n                                <\/div>\n                            <\/div>\n                            <div class=\"row\" style=\"width:100%;padding:0px 5px;float:left;margin:0px 5px;\">\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding-right:5px;font-size:17px;\"><br>\n                                    <label>\n                                        Organization Name*<br>\n                                        <span style=\"color:#707070;font-weight:normal;\">e.g. Springfield Learning Center<\/span><br>\n                                        <input type=\"text\" name=\"disName\" id=\"disName\" value=\"\" size=\"40\" required style=\"margin:5px 0px;font-weight:normal;border:1px;border-radius:5px;\">\n                                    <\/label>\n                                <\/div>\n                            <\/div>\n                            <div class=\"row\" style=\"width:100%;padding:0px 5px;float:left;margin:0px 5px;\">\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding-right:5px;font-size:17px;\"><br>\n                                    <label>\n                                        Organization Website<br>\n                                        <span style=\"font-size:13px;font-weight:normal\">This is the webpage clients will return to after completing an assessment<\/span><br>\n                                        <input type=\"text\" name=\"url\" id=\"url\" value=\"\" size=\"40\" style=\"margin:5px 0px;font-weight:normal;border:1px;border-radius:5px;\">\n                                    <\/label>\n                                <\/div>\n                            <\/div>\n\n                            <div class=\"row\" style=\"width:100%;padding:10px 5px;float:left;margin:0px 5px;\">\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding-right:5px;font-size:17px;\">\n\n                                                                        <br><label for=\"package\">Select Pro Subscription (public domain)<\/label>\n                                    <table style=\"width:100%;border:0px;\">\n                                        <tr>\n                                            <td style=\"width:30%;vertical-align:top;border:0px;\">\n                                    <select name=\"package\" id=\"package\" style=\"border:1px;border-radius:5px;\">\n                                        <option value=\"1\" selected>Monthly<\/option>\n                                        <option value=\"2\">Annual<\/option>\n                                    <\/select> \n                                            <\/td>\n                                            <td style=\"border:0px;width:100%;\">\n                                    <input type=\"radio\" id=\"config1\" name=\"config\" value=\"config1\" checked>\n                                    <label for=\"config1\">Early Childhood ISC (CDC-based)<\/label><br>\n                                    <input type=\"radio\" id=\"config2\" name=\"config\" value=\"config2\">\n                                    <label for=\"config2\">Mental &#038; Behavioral Health ISC<\/label><br>\n                                           \n                                    <input type=\"radio\" id=\"config3\" name=\"config\" value=\"config3\">\n                                    <label for=\"config3\">School Age ISC<\/label><br>\n\n                                       <input type=\"radio\" id=\"config4\" name=\"config\" value=\"config4\">\n                                    <label for=\"config4\">Pain Management ISC<\/label><br>\n                                         \n                                        <\/tr>\n                                    <\/table>                                   \n                                                                        \n                                                                        \n\n                                <\/div>\n                            <\/div>\n\n\n\n                        <div class=\"row\" style=\"width:100%;padding:0px 5px;float:left;margin:0px 5px;\">\n                            <div style=\"float:left;display:table-column;width:100%; text-align:left;padding:20px 0px 0px;font-size:17px;\">\n                                Terms and Conditions<br>\n                                <div style=\"float:left;display:table-column;width:100%; text-align:left;padding:5px 0px 0px;font-size:12px;\">\n                                    <textarea name=\"eulabody\" rows=\"8\" style=\"max-width:500px;width:100%;border-radius:5px;border:none;background-color:#f4f4f4;padding:10px\">\nSELECTING THE &#8220;ACCEPT&#8221; CHECKBOX, OR USING THIS APP AND OUR SITE, MEANS THAT YOU AGREE TO OUR ENTIRE TERMS AND CONDITIONS.\n\nIf you use this app or website, you are responsible for adhering to the Terms and Conditions as well as maintaining compliance with all applicable laws and regulations. You are additionally responsible for maintaining your account and password and exercising due diligence to protect your account security.\n\nWe reserve the right to cancel your account and deny access to this service if you violate the Terms and Conditions. \n\nAny personal information collected on this app or our site is governed by our Website Privacy Statement. \n\nTHE APP AND SITE IS OFFERED &#8220;AS IS.&#8221; THERE ARE NO GUARANTEES OF THE ACCURACY OR COMPLETENESS OF THE INFORMATION OR SERVICES PROVIDED ON THE APP OR SITE. Patient Tools is not responsible for any damages you may incur due to errors in the content, security, or privacy of this app, site, or third-party websites that may be accessed from this site. You use this app and site at your own risk and assume all responsibility for doing so. Your only remedy if you are dissatisfied with the app or site is to stop using it. \n\nOccasionally, we may make changes to the Terms and Conditions.\n\nPatient Tools results are for general informational purposes only. Patient Tools is not intended to diagnose, treat, cure, or prevent any medical or mental health disease or condition. Patient Tools results are not medical or mental health advice and are not a substitute for a thorough medical and\/or mental health evaluation by a credentialed and licensed healthcare professional. It is your responsibility to read the site Terms and Conditions from time to time. Your continued use of the app and site will indicate your agreement to the revised Terms and Conditions. \n\nDisclaimer: Patient Tools, Inc is a technology company that provides access to screening and assessment tools for healthcare and mental healthcare. Patient Tools does not provide medical or mental health advice or services to its customers or users. Diagnosis and treatment decisions must be made by a qualified healthcare professional. Patient Tools employees, consultants and agents shall not be liable for any claims or damages, and expressly disclaim all liability of any nature for any action or non-action taken as a result of the information generated by the Patient Tools website or any of its programs.\n                                    <\/textarea>\n                                    <br \/>\n                                    <input type=\"checkbox\" required id=\"eulaAccept\" name=\"eulaAccept\"><label for=\"eulaAccept\" style=\"font-size:15px;font-weight:normal;\"> &nbsp; &nbsp;Accept*<\/label>\n\n                                <\/div>\n                            <\/div>\n                        <\/div>\n\n                    <\/div>\n\n                    <div class=\"row\" style=\"font-size:15px;width:100%;color:black;\">&nbsp;<\/div>\n                    <div class=\"row\" style=\"font-size:15px;width:100%;margin-left:0px;color:black;\">*required<\/div>\n\n\n\n\n                            <div class=\"row\" style=\"width:50%;padding:0px 5px;float:left;margin:0px 5px;margin-top:25px;\">\n                                <input style=\"display: table; background-color:#52B68F; font-size: 15px; border-radius:20px\" type=\"submit\" value=\"Check Out\" id=\"subBTN\">\n                            <\/div>\n                        <\/div>\n                    <\/div>\n                    <input type=\"hidden\" id=\"requestReturnURL\" name=\"requestReturnURL\" value=\"https:\/\/www.patienttools.com\/index.php\/pricing\/provision\/\">\n                    <input type=\"hidden\" id=\"setupReturnURL\" name=\"setupReturnURL\" value=\"https:\/\/www.patienttools.com\/index.php\/pricing\/success\/\">\n                    <input type=\"hidden\" id=\"accountexistsReturnURL\" name=\"accountexistsReturnURL\" value=\"https:\/\/www.patienttools.com\/index.php\/pricing\/account-exists\/\">\n                    <input type=\"hidden\" id=\"requestReturnErrorURL\" name=\"requestReturnErrorURL\" value=\"https:\/\/www.patienttools.com\/index.php\/pricing\/error\/\">\n                    <input type=\"hidden\" id=\"cancelReturnURL\" name=\"cancelReturnURL\" value=\"https:\/\/www.patienttools.com\/index.php\/pricing\/\">\n                    <input type=\"hidden\" id=\"accountReqCode\" name=\"accountReqCode\" value=\"9354PTIPro\">\n                    <input type=\"hidden\" id=\"contactinfosubmit\" name=\"contactinfosubmit\" value=\"1\">\n                    <input type=\"hidden\" id=\"submitContext\" name=\"submitContext\" value=\"subscribe\">\n                    <input type=\"hidden\" id=\"infoRequest\" name=\"infoRequest\" value=\"subscribe\">\n                    <input type=\"hidden\" id=\"defURL\" name=\"defURL\" value=\"https:\/\/www.childnav.com\/subscribe\/default-return\/\">\n\n                <\/form>\n\n                <!--<p style=\"display:none;margin-top:40px;\"><button onClick=\"validForm();\" id=\"subBTN\" disabled style=\"display:table;opacity:.6;border-radius:20px;box-shadow:0px 0px;\">send<\/button><\/p>\n                <table>\n                    <tr id=\"grayOut\" style=\"display:none;margin:10px auto 20px 0px;\">\n                        <td style=\"text-align:center;padding:20px 0px;\">\n                            <a onclick=\"openBox2()\" style=\"display:table;box-shadow:0px 0px;border-radius:20px\"><span class=\"PSbtn3\">Send<\/span><\/a>\n                        <\/td>\n                    <\/tr>\n                    <tr id=\"startBtn\" style=\"display:table;margin:10px auto 20px 0px;\">\n                        <td style=\"text-align:center;padding:20px 0px;\">\n                            <button onClick=\"openBox1();\" id=\"subBTN\" disabled style=\"display:table;opacity:.6;box-shadow:0px 0px;border-radius:20px\">Check Out<\/button>\n                        <\/td>\n                    <\/tr>\n                <\/table>-->\n                <div id=\"check\" style=\"display:none;background:rgba(0,0,0,0.8);position:fixed;top:0;left:0;width:100%;height:100%;z-index:3\">\n                    <table style=\"position:fixed;z-index:4;background:#b8b8b8;color:black;top:10vh;left:10%;width:80%;\">\n                        <tr>\n                            <td style=\"background:#a1a1a1;text-align:left;padding:5px;font-weight:bold;\">Terms of Use<\/td>\n                            <td style=\"background:#a1a1a1;text-align:right;padding:5px;\"><a style=\"color:black\" onclick=\"closeBox()\">X<\/a><\/td>\n                        <\/tr>\n                        <tr>\n                            <td colspan=\"2\" style=\"padding:10px;background:#b8b8b8;text-align:left;\">\n                                <div style=\"height:400px;width:100%;border:1px solid #ccc;overflow-y:scroll;padding:5px;\">\n                                    <div style=\"text-align:center;font-weight:bold;\"><br>Summary of our Terms and Conditions<br><\/div><br>\n                                    <p style=\"display:table;line-height:.5;\"> &nbsp;<\/p>\n                                    <p style=\"display:table;\">CLICKING THE <b>ACCEPT<\/b> BUTTON, OR USING THIS APP AND OUR SITE, MEANS THAT YOU AGREE TO OUR ENTIRE TERMS AND CONDITIONS. <\/p>\n                                    <p style=\"display:table;\">If you think you or your child are having a medical or psychiatric emergency, call 911 or go to the nearest hospital. Do not delay seeking treatment or medical advice because of something you have read in this app or on our website. This app connected through our site provides access to general screening services. It is not a substitute for professional medical advice.<\/p>\n                                    <p style=\"display:table;\">If you use this app or our site, you are responsible for: following our site policies and applicable law in your use of the site, and keeping your password and account. <br><br>We reserve the right to cancel your account and deny you access to this app or our site if you violate the site Terms and Conditions. <br><br>Any personal information collected on this app or our site is governed by our Website Privacy Statement. <br><br>THE APP AND SITE IS OFFERED \\&#8221;AS IS.\\&#8221; THERE ARE NO GUARANTEES OF THE ACCURACY OR COMPLETENESS OF THE INFORMATION OR SERVICES PROVIDED ON THE APP OR SITE. Child Nav is not responsible for any damages you may incur due to errors in the content, security, or privacy of this app, site or third-party websites that are accessed from this site<br><br>You use this app and site at your own risk and assume all responsibility for doing so. Your only remedy if you are dissatisfied with the app or site is to stop using it. <br><br>Occasionally, we may make changes to the Terms and Conditions. <\/p>\n                                    <p style=\"display:table;\">The Service is for general informational purposes only and is not intended to diagnose, treat, cure, or prevent any medical or mental health disease or condition. Test results are not medical or mental health advice and are in no way to be interpreted as a a substitute for a thorough medical and\/or mental health evaluation by an appropriately credentialed and licensed healthcare professional. It is your responsibility to read the site Terms and Conditions from time to time. Your continued use of the app and site will indicate your agreement to the revised Terms and Conditions. <br><br>Disclaimer: Child Nav, LLC is a technology company that provides access to screening tools for development, mental health, behavioral health, and other issues. Child Nav does not provide any medical, psychological, or professional services to its customers or users. For an accurate medical or mental health diagnosis, please see a qualified professional. Child Nav employees, consultants and agents shall not be liable for any claims or damages, and expressly disclaim all liability of any nature for any action or non-action taken as a result of the information generated by the Child Nav website or any of its programs. If you or a loved one is experiencing a medical emergency, please contact emergency services.<\/p>\n                                    <\/div>\n                            <\/td>\n                        <\/tr>\n                        <tr>\n                            <td colspan=\"2\" style=\"text-align:center;padding:5px;\"><a onClick=\"validForm();\" style=\"text-decoration:none;font-size:25px;color:black\"><span style=\"background:#a1a1a1;text-align:center;border:solid 1px black;font-size:15px;font-family:Verdana, Geneva, sans-serif;font-variant: small-caps;padding:0px 35px 2px;cursor:pointer;\">accept<\/span><\/a><\/td>\n                        <\/tr>\n                    <\/table>\n                <\/div>\n                <script>\n                    function closeBox() {\n                        document.getElementById(\"check\").style.display = \"none\";\n                    }\n                    function openBox1() {\n                        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<input type=\"hidden\" id=\"Profession\" name=\"Profession\" value=\"\">\n                    <input type=\"hidden\" id=\"otherProf\" name=\"otherProf\" value=\"\">\n                    <input type=\"hidden\" id=\"licensed\" name=\"licensed\" value=\"\">\n                    <input type=\"hidden\" id=\"Location\" name=\"Location\" value=\"\">\n                    <input type=\"hidden\" id=\"otLoc\" name=\"otLoc\" value=\"\">\n                    <input type=\"hidden\" id=\"comment\" name=\"comment\" value=\"\">\n\n            <\/td>\n        <\/tr>\n    <\/table>\n<\/center>\n                <\/form>\n<script>\n    function validForm() {\n        var website = \"https:\/\/www.childnav.com\/subscribe\/sign-up-addition\/?\";\ndocument.getElementById(\"signupForm\").submit();\n    \/\/if (document.forms['signupForm'].elements['licensed'].value == 2 && document.forms['signupForm'].elements['Profession'].value != \"Other\") {\n    \/\/    document.getElementById(\"signupForm\").submit();\n  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 \/\/    document.forms['validForm'].elements['firstName'].value = document.forms['signupForm'].elements['firstName'].value;\n    \/\/    document.forms['validForm'].elements['lastName'].value = document.forms['signupForm'].elements['lastName'].value;\n    \/\/    document.forms['validForm'].elements['email'].value = document.forms['signupForm'].elements['email'].value;\n    \/\/    document.forms['validForm'].elements['disName'].value = document.forms['signupForm'].elements['disName'].value;\n    \/\/    document.forms['validForm'].elements['url'].value = document.forms['signupForm'].elements['url'].value;\n    \/\/    document.forms['validForm'].elements['Profession'].value = document.forms['signupForm'].elements['Profession'].value;\n    \/\/    document.forms['validForm'].elements['otherProf'].value = document.forms['signupForm'].elements['otherProf'].value;\n    \/\/    document.forms['validForm'].elements['licensed'].value = 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response + \"||secret=6LeHJgsUAAAAALj-9gEhl76UHU8piou27FnkJSJ6||\";\n\n        \/\/ response = getData('aform', response);\n\n        \/\/alert(response);\n\n        \/\/submitBigData(response);\n\n        if (document.getElementById(\"firstName\").value.length == 0) {\n            alert(\"Missing First Name\");\n            loadGreCaptcha();\n        }\n        else if (document.getElementById(\"lastName\").value.length == 0) {\n            alert(\"Missing Last Name\");\n            loadGreCaptcha();\n        }\n        else if (document.getElementById(\"email\").value.length == 0) {\n            alert(\"Missing Email\");\n            loadGreCaptcha();\n        }\n        else if (document.getElementById(\"disName\").value.length == 0) {\n            alert(\"Missing Agency Name\");\n            loadGreCaptcha();\n        }\n            \/\/else if(document.getElementById(\"Profession\").value.length == 0)\n            \/\/{alert(\"Missing Profession\");loadGreCaptcha();}\n            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rel=\"stylesheet\"><meta name=\"viewport\" content=\"width=device-width, initial-scale=1\"><link rel=\"stylesheet\" href=\"https:\/\/maxcdn.bootstrapcdn.com\/bootstrap\/3.4.1\/css\/bootstrap.min.css\">\n<script src=\"https:\/\/ajax.googleapis.com\/ajax\/libs\/jquery\/3.5.1\/jquery.min.js\"><\/script>\n<script src=\"https:\/\/maxcdn.bootstrapcdn.com\/bootstrap\/3.4.1\/js\/bootstrap.min.js\"><\/script>\n<\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>Sign Up Pro *required items &nbsp; Account First Name* Account Last Name* Account Email* Organization Name* e.g. Springfield Learning Center Organization Website This is the webpage clients will return to after completing an assessment Select Pro Subscription (public domain) MonthlyAnnual Early Childhood ISC (CDC-based) Mental &#038; Behavioral Health ISC School Age ISC Pain Management ISC &#8230; <a title=\"Sign Up Pro\" class=\"read-more\" href=\"https:\/\/www.patienttools.com\/index.php\/pricing\/sign-up-pro\/\" aria-label=\"Read more about Sign Up Pro\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":339,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-855","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/pages\/855","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/comments?post=855"}],"version-history":[{"count":30,"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/pages\/855\/revisions"}],"predecessor-version":[{"id":1113,"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/pages\/855\/revisions\/1113"}],"up":[{"embeddable":true,"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/pages\/339"}],"wp:attachment":[{"href":"https:\/\/www.patienttools.com\/index.php\/wp-json\/wp\/v2\/media?parent=855"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}