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Ambassador Health Alliance
Ambassador Health Development

Join Our Network

 
If you are a patient in our network or you wish to join, please complete form below
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I am currently a member of Ambassador Care as a:
 patient     doctor     hospital
 other healthcare provider     other




I wish to know more about joining Ambassador Care as a:
 patient     doctor     hospital
 other healthcare provider     other
I was referred by:
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Age
Nation:   Zip: 
Email:
U.S. Phone:   Fax: 
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(If applicable)
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Nation:
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I am in the U.S. Medicare program:  Yes    No
Citizenship:
If you are a patient, specify your health plan
If you are a doctor, your specialty
Website:
(if you have one)
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