Premier Health Care Management
Answer the following questions so we can start the application process. Please allow 3-4 weeks to be credentialed after the agreement is signed. Once answers are submitted, we will send over agreement to electronically sign.
How did you hear about Borrego Health Foundation and Premier Health Care Management?
Are you currently accepting Medi-Cal patients?
What is your exact business name registered with the Secretary of State business website? (ex: John H Smith DDS Inc, a Dental Corporation)
What is the address of your practice?
What is your business phone number?
What is the business email address?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service