Contact Us

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123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

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Link to read me page with more information.

Join Us

alliance membership information

Thank you for your interest in joining the Alliance.  Please complete the form below with some brief organizational information to begin the process.  We will be in touch promptly following your submission and look forward to working together soon.


Your Name *
Your Name
Lead Contact Information *
Lead Contact Information
Please provide the contact information for the Site Champion/SuperUser/Leader
What are the current settings of care at your organization? *
Please check all that apply.
Please provide the name of the vendor who provides your EMR services.

Thank you for taking the time to complete this form and for your interest in joining the GPCQA!  We will be in touch promptly to discuss your needs and opportunities. 

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