NCMS & NCMGMA Prior Authorization Survey 
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What county is your practice located in? *

Could we contact you, if needed, for additional information or to set up a meeting with your state Representatives on Prior Authorizations? 

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Name (this information will not be shared publicly) *
Email  (this information will not be shared publicly) *
Practice Name  (this information will not be shared publicly) *
Is your practice..... *
About how many staff are employed at your practice? *
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