Academic/Public Health Detailing Request Form
Academic/Public Health Detailing is a free educational opportunity for clinical providers in the state of Colorado. The goal of Detailing is to provide updated, evidence-based clinical practice guidelines and resources to providers in an efficient and practice-friendly format.
Email address *
Practice Information
Practice Name *
Your answer
Practice Type *
Required
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
County *
Website
Your answer
Tell us about who is in your practice
Note: Services are geared toward clinical prescribers; however, other staff are welcome to attend.
Number of Prescribers in Practice
Your answer
Number of Other Clinical Staff
Your answer
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