Copay Accumulator Tri-fold Request
This resource should be available to all your patients to empower them to have a meaningful conversation with their employer. NCODA members use this form to let us know how many and where to send this resource as a tri-fold brochure. Printing and shipping cost is complimentary for all our members. If you are not a NCODA member, please join at https://www.ncoda.org/register/ to have tri-folds sent to your practice!
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Practice Name *
Name *
Email *
Shipping Address (Please do not use a PO box) *
Indicate the number of tri-folds to send *
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