AII Facility Registration

Facility Registration
Facility Administrator Registration
Administrator Identity Verification
Services Agreement
Access level
Fees/Donations

Step 1

Register your facility

Please enter information specific to your facility.

Facility Name
Facility Address

City

State

Zipcode

Phone Number

Facility Logo

Please list the approximate population of the city in which you practice

Would you describe your facility as (select all that apply)

Services provided at your facility (select all that apply)

Other Service(s):
(Please separate different services with a comma)

If surgery is picked as a service - Please list the level of training completed by the surgeons (select all that apply)

Step 2

Register your facility administrator

This is the user who will oversee all administrative duties.
Please enter information specific to the facility administrator.

Admin First Name

Admin Last Name

Admin Title

Admin Home Address*

Admin City*

Admin State*

Zipcode

Admin Year of Birth*

Last 4 Digits of Admin Social*

Username

Password

Password must contain a letter, a number, and is at least 8 characters in length.

Email
Phone Number

* Address, YOB, and the last 4 digits of SSN are required only to verify the credible identity of the admin user.
* Upon clicking "Next," a few questions will be asked to further verify the credible identity of the admin user. This data is not used or shared for any other purposes.

Step 3

Please complete all of the following questions so we may validate your identity before continuing with registration.

International Users may skip this step. Please click "Continue".

Step 4

Accept the terms of the services agreement

By clicking next, you agree to the terms of the services agreement.

Step 5

Choose an access level

Hermes Basic

Features	Cost
- Communication - Care Coordination - Facility Level Data Tracking	Free^*

Hermes Plus

Features	Cost
- Hermes Basic - Your Facility Data compared to Aii Aggregate in bi-annual reports	$499/ yr

Special Project

Please contact admin@aii-hermes.org for information regarding tailored data analytic services

^*As a a nonprofit organization, our goal is to provide the best service for the lowest possible price.
For this reason, we have waived the typical basic registration fee of $199

Step 6

Complete Payment Process

Name (as it appears on your card)

Card number

Expiration (MM/YY)

Security Code

As a non-profit 501(c)3 organization, your contribution will significantly help the Auditory Implant Initiative advance cochlear implant care.

Please consider selecting one of the amounts below, or any other amount by typing in the text box

$50

$100

$500

$1000

Payment Summary

Fee	$
Donation	$
Total to be charged	$