Rev-Up DC: Behavioral Health Provider Interest Survey
Please complete the following Rev-Up DC: Behavioral Health Provider Survey at your earliest convenience.

After you submit the survey, we will follow up with you via email or phone call.

Feel free to contact our team at with any questions, comments or concerns.
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Full Name *
Job Title *
Phone Number *
Email Address *
What is the name of your practice / facility? *
What is the size of your practice? *
Are you an ASARS or SUD provider? *
Are you a DBH certified provider? *
Are you CURRENTLY participating in Integrated Care DC? *
Are you INTERESTED in participating in Rev-Up DC? *
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