ATD Healthcare Solutions

First Name *

Last Name *

Title: *

Employment Status: *

Phone *

Email *

What state are you in? *

Do you own your own private practice? *

Yes

No

Have you visited our Scrubs to Busines Program Website?

Yes

No

If selected as a good fit to do business together we will work with you to land a High Earning Care Management Contract with a Practice in your community. How many private practices and/or Provider owners do you feel would entrust you with managing their Chronic Care Patient Population? *

We are experts in supporting our clients ability to land Chronic Care Management Contracts. Do you understand that our program requires you to run and manage your own busines and if selected will require a Software Licence one time cost of $1997?

Yes

No

Are you in a position to invest $1997 towards your CCM/RPM software licence enabling a business partnership?