Thank you for your interest!

Below is the registration form. Don't worry about having a solid BTVH plan yet, we will be in touch soon with information about how to roll this out to your patients! HCA will be holding a series of conference calls to talk with BTVH Champions (your agency's point person) about how to get going! We will also be here along the way for troubleshooting and assistance!

* 1. Provide us with some information about you!

* 2. Please identify the individual within your agency that will serve as the BTVHNY Champion or point person (if different from yourself).

* 3. How many BTVHNY distribution packets would you like us to send? In other words, how many patients do you plan to distribute the materials to? (Ex: 100, 250, 500, etc.)