Clinical
Agreement Request Form
Complete
and submit the following form and an agreement will be sent to the
facility within two business days. To check the status of the agreement,
please search our Clinical
Database. In order to expedite processing, please provide all
of the requested information. Required fields are marked with
an asterisk (*). Any missing information may delay processing.
It
is highly recommended that you contact the facility and request a Certificate
of General Liability Insurance that meets the District's insurance
requirements upon completion of this request form. We are unable to
process any agreements without proper insurance coverage.
An e-mail confirmation will be sent to you once your request has been
processed. If you have any questions, please contact Chanda
Fraulino at 480-731-8881.
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