Director Patient Access

<link rel='stylesheet' type='text/css' href='https://static.ctctcdn.com/h/contacts-embedded-signup-assets/1.0.2/css/signup-form.css'><div class="ctct-embed-signup" style="font: 16px Helvetica Neue, Arial, sans-serif; font: 1rem Helvetica Neue, Arial, sans-serif; line-height: 1.5; -webkit-font-smoothing: antialiased;"> <div style="color:#5b5b5b; background-color:#e8e8e8; border-radius:5px;"> <span id="success_message" style="display:none;"> <div style="text-align:center;">Thanks for signing up!</div> </span> <form data-id="embedded_signup:form" class="ctct-custom-form Form" name="embedded_signup" method="POST" action="https://visitor2.constantcontact.com/api/signup"> <h2 style="margin:0;">Subscribe to our Newsletter!</h2> <p>Sign up to get career and interview tips sent right to your inbox!</p>  <input data-id="ca:input" name="ca" value="--CA_REPLACE--" type="hidden"> <input data-id="source:input" name="source" value="EFD" type="hidden"> <input data-id="required:input" name="required" value="list,email" type="hidden"> <input data-id="url:input" name="url" value="" type="hidden"> <p data-id="Email Address:p" ><label data-id="Email Address:label" data-name="email" class="ctct-form-required">Email Address</label> <input data-id="Email Address:input" name="email" value="" maxlength="80" type="text"></p> <p data-id="First Name:p" ><label data-id="First Name:label" data-name="first_name">First Name</label> <input data-id="First Name:input" name="first_name" value="" maxlength="50" type="text"></p> <button type="submit" class="Button ctct-button Button--block Button-secondary" data-enabled="enabled">Sign Up</button> <div><p class="ctct-form-footer">By submitting this form, you are granting: American Consultants, 9359 West 75th Street, Overland Park, Kansas, 66204, United States, https://thehealthcarepeople.com/ permission to email you. You may unsubscribe via the link found at the bottom of every email. (See our <a href="http://www.constantcontact.com/legal/privacy-statement" target="_blank">Email Privacy Policy</a> for details.) Emails are serviced by Constant Contact.</p></div> </form> </div></div><script type='text/javascript'> var localizedErrMap = {}; localizedErrMap['required'] = 'This field is required.'; localizedErrMap['ca'] = 'An unexpected error occurred while attempting to send email.'; localizedErrMap['email'] = 'Please enter your email address in name@email.com format.'; localizedErrMap['birthday'] = 'Please enter birthday in MM/DD format.'; localizedErrMap['anniversary'] = 'Please enter anniversary in MM/DD/YYYY format.'; localizedErrMap['custom_date'] = 'Please enter this date in MM/DD/YYYY format.'; localizedErrMap['list'] = 'Please select at least one email list.'; localizedErrMap['generic'] = 'This field is invalid.'; localizedErrMap['shared'] = 'Sorry, we could not complete your sign-up. Please contact us to resolve this.'; localizedErrMap['state_mismatch'] = 'Mismatched State/Province and Country.'; localizedErrMap['state_province'] = 'Select a state/province'; localizedErrMap['selectcountry'] = 'Select a country'; var postURL = 'https://visitor2.constantcontact.com/api/signup';</script><script type='text/javascript' src='https://static.ctctcdn.com/h/contacts-embedded-signup-assets/1.0.2/js/signup-form.js'></script>

Director Patient Access

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