Small Group Interest Form

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Small Group Interest Form

Your Name

Name of your group

City, State

Number of Hospitals Where Your Group Practices?

Number of Physicians in Your Group

Would You Like to Get Involved? Considered for an Small Group Advisory Group Join the engagED community to network with other small group members Be interviewed or write an article about my small group's best practices for ACEP Now Be interviewed for a Frontline Podcast on my small group's best practices

What are the most challenging operational issues impacting your small group practice?

What kinds of resources or products would be valuable from ACEP?

Email Address to Follow Up

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