* Indicates a required field
First Name *
Do you spend at least 50% of your week practicing medicine? * YesNo
Last Name *
Are you a board-certified physician? * YesNo
Email *
Medical Specialty * Family MedicineInternal MedicinePediatricsOBGYNGeneral SurgeryOther/Not listed
States Licensed In *
List Other Specialty
Medical License Number *
How Did You Hear About the PCC?
By checking this box, you agree to receive emails from 98point6 and indicate you have read and agreed to the Primary Care Council Agreement. * Yes
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