Leasing Space (HCP Survey)
This form allows us to match you with a compatible clinic based on your needs
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What is your professional designation?
Do you require equipment to see your patients/client in clinic?
If yes, what kind of equipment do you require?
Please provide your college registration #
Please provide your liability insurer and policy #
What day(s) would you like to be in clinic? (select all that apply)
Where would you like to lease space for your clients? Please provide city and details about area preferred.
Are you willing to commit to a three month minimum lease?
How much are you willing to pay for renting space in the clinic?
up to $450 a month
$451-$750 a month
$1000 or more
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