Before applying, please review the Enhanced Respiratory Care Standards.

To apply to become an accredited healthcare facility, please complete this form or email physicianpatientalliance@gmail.com:

Company/Organization *

Name *

First

Last

Email *

Phone *

Name of Healthcare Facility to Accredit (if more than one, please list others below) *

Address of Healthcare Facility to Accredit *

If There is More than 1 Facility to Accredit, Provide Names and Addresses

Does your healthcare facility currently have any regulatory or compliance issues? *YesNo

If Yes, Please Describe the Regulatory or Compliance Issue

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