ACP Advance Chronic Pain QI Program Application

1.First name(Required.)
2.Last name(Required.)
3.Practice name(Required.)
4.Email address(Required.)
5.Phone number
6.City(Required.)
7.State(Required.)
8.Do you have support from senior leadership in your organization to participate in the ACP's Chronic Pain QI initiative?
9.Are you able to attend the Virtual Training Webinar on November 20, 2019 from 6:00 pm-8:00 pm EST?(Required.)
10.Indicate your agreement with the following statements:
Rating
Many of my patients are uninsured or underinsured
I practice in a medically underserved community
Current Progress,
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