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CQIC Sign Up Form

If you are interested in receiving support from the Advancing Clinical Excellence Network and enjoying our exclusive benefits, please fill out the brief form below.

Learn more about the Network and read frequently asked questions.

2. Organization Address *This question is required.
(The network is only operating in seven states.)
3. Primary Point of Contact
This question requires a valid email address.
(Physicians, RNs, and other licensed practitioners) This question requires a valid number format.
6. What could your practice use the most support on when it comes to quality improvement?(Check all that apply)
7. Do you currently use an EHR?