FLANP List of NP-owned & operated businesses in Florida
This form is to help FLANP gather information to educate representatives in Tallahasee on how many clinics/medical practices would be affected by the proposed bills, HB 345 and SB 316. If you have any questions, please contact admin@flanp.org.
Sign in to Google to save your progress. Learn more
Email *
Your Name & Title *
Name of your business *
Number of patients served *
Physical location - address *
Do you employ a physician? *
You may check multiple committees.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report