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If you're interested in the possibility of being a preceptor and would like more information, please tell us a little bit about yourself on the form below and someone will contact you , usually within 2 business days:
Your Name:*
The Name of Your Clinic/Pharmacy/Hospital:*
Your Specialty:
The Address of Your Practice:*
Your Phone Number:*
Best Times To Call You:
Your Fax:
Your E-Mail:*
How Many Students You're Interested in Precepting:
* = Required
CHP Interdisciplinary Case Conference