Permission Request Form

Hello and thank you for your interest in our materials!

In order to process your permission request, we need specific information about your organization and your intended use of our online health information.

Please review our Terms of Use, and Privacy Policy, then completely fill out and submit the permission request form below. Please allow 14-21 days for a response to your request.

All fields are required.

Please enter the name and URL(s) of your group/organization:

Group/Organization Name:

Group/Organization URL(s):

Please enter a contact name and e-mail address:

Contact Name:

Contact E-Mail Address:

Please describe the mission of your organization/group:

Please list the name(s) and URL(s) of the materials for which you are requesting permission:

Please explain how you would like to use these materials. Please be specific: include URL(s)/publication name(s), target audience, whether the material(s) will be distributed for free or sold, whether the materials will be edited or otherwise modified, etc.

When you click "Submit" your request will be sent to our staff for consideration.

Please wait several seconds after clicking, for the form to be sent.

If you have any questions, comments, or difficulties with this form, please contact us at YMH@childrens.harvard.edu.

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