Healthcare Technology Consulting
  Client Site - Access Request  
 

Please complete the Registration Information form below and click Submit when you have finished. We will send you notification via email when your request has been processed.


Project data on the client site is updated real time.

 
 

Registration Information                  * Required Field
*First Name:   
*Last Name: :  
*Title:   
*Firm/Hospital:   
*Project Name(s):   
Address: 
*City:   
*State:   
*Zip:   
*Phone:   
Fax: 
*Email Address:   
*GBA Associate/Contact:   

Password Entry
*Password (minimum 6 chars)    
*Re-enter Password: 

*Agreement Terms   
  I am agreeing that a copy of this request will be sent to the GBA project manager and the hospital's project manager for approval. I also understand that the data and reports provided here are for informational review purposes only.

     


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