Connect with Inclusive Health Partners (IHP)

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1. Name (Required.)

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2. Organization

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3. Email (Required.)

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4. Would you like to connect one-on-one with the IHP team? (Required.)

Yes

Maybe - I'd like more information

Not at this time

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5. What would you like to connect about? (Select all that apply.)

MAIA

Medicare Advantage education

A question related to the recent webinar

Using MAIA as a resource within a CIL or SILC

Using MAIA as a resource for myself or someone I support

Resources or information

Partnership or collaboration

Other (please specify)

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6. Tell us a little about what you would like to discuss.

You do not need to provide a lot of detail. A few sentences will help IHP understand how they can best support you.

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7. How would you prefer to connect? (Required.)

Virtual Call

Phone

No preference

Other (please specify)

Connect with Inclusive Health Partners (IHP)

Question Title

* 1. Name (Required.)

Question Title

* 2. Organization

Question Title

* 3. Email (Required.)

Question Title

* 4. Would you like to connect one-on-one with the IHP team? (Required.)

Question Title

* 5. What would you like to connect about? (Select all that apply.)

Question Title

* 6. Tell us a little about what you would like to discuss.You do not need to provide a lot of detail. A few sentences will help IHP understand how they can best support you.

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* 7. How would you prefer to connect? (Required.)

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* 8. Do you have any access or communication needs we should consider when coordinating the meeting?

1. Name (Required.)

2. Organization

3. Email (Required.)

4. Would you like to connect one-on-one with the IHP team? (Required.)

5. What would you like to connect about? (Select all that apply.)

6. Tell us a little about what you would like to discuss.

You do not need to provide a lot of detail. A few sentences will help IHP understand how they can best support you.

7. How would you prefer to connect? (Required.)

8. Do you have any access or communication needs we should consider when coordinating the meeting?