Address

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* 1. Address

What type of ATP membership are you interested in finding out more about? (Check all that apply.)

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* 3. What type of ATP membership are you interested in finding out more about? (Check all that apply.)

What type of assistance are you seeking from ATP? (Check all that apply.)

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* 4. What type of assistance are you seeking from ATP? (Check all that apply.)

Do you currently have any telemedicine/telehealth programs in place?

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* 5. Do you currently have any telemedicine/telehealth programs in place?

Are you looking at starting or expanding telemedicine/telehealth programs?

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* 6. Are you looking at starting or expanding telemedicine/telehealth programs?

Best way to contact you

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* 7. Best way to contact you

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