HCC Toolkit Project Team Registration

About your practice

Thank you for your interest in participating in the HCC Toolkit Project Team! To get started, we will need some information from you about your practice and team members.

Question Title

* 1. Please provide the following information.

Primary Contact Name

Primary Contact Email Address

Practice Name

Address

City

Question Title

* 2. What type of practice is it?

Private

Hospital System

FQHC

Other (please specify)