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* 1. Please enter your first and last name (including your preferred title).

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* 2. What organization are you representing/apart of?

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* 3. What is your role within the organization?

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* 4. What is your preferred email address?

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* 5. Where are you located? (City, state)

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* 6. What does your business/organization offer?

Thank you for your interest in being apart of our catalog of community health resources!

 The Healthcare Plug is a medical concierge service that helps people in low socioeconomic and medically underserved communities get connected with doctors they can relate to. Our ultimate goal is to eradicate the barriers that prevent Black + Brown people from prioritizing their health--and building this directory of resources is a MAJOR step towards making it happen.

We'll send you an email update soon to begin getting your business/organizational profile established!

Any further questions or concerns can be sent to TheHCPlug@gmail.com.

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