Office Pilot Lead Contact Information (email and phone number)
Your answer
Office Address and location
Your answer
Number of employees including administrative, medical assistant and medical providers (e.g. -physicians, physician assistant or nurse practitioner).
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Please explain why you would like to participate in the pilot.
Your answer
Please check which items your office would like support with:
Thank you for your interest in our pilot project, expect to hear from us by November 30th, 2021. Please provide any additional information or comments.