Change/Update Practice Information:

If you have changed your practice information, we want to know! Please fill in any areas that have recently changed and hit the “Send” button. The information pertains to the waiting room where the AccentHealth patient education system is located.

Office InformationCorrections/Changes
Office/Practice Name
Office Address (include suite number, floor, etc.)
City:
State:   Zip:
Office Phone Number
Primary Contact Name
Primary Contact Phone Number
Primary Contact Fax Number
Primary Contact Email Address
Waiting Room Name/Location (Main, ER, etc.)
Number of Patients Seen in WR Per Week
Office Hours Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Update Hours
Add/Delete/Modify?Practitioner NameDegreeSpecialty# Hours/Week

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