Program Enrollment Inquiry Form

PatientPoint

Enter your information to apply for any of our PatientPoint programs.


Act now. Enrollment is limited and only available for select offices. Please submit your practice information below and we'll get back to you in two business days. Or contact us at 1-800-284-8314.

*Indicates Required Field

*First Name  
*Last Name  
Role
*E-mail Address  
*Phone Number  
*Practice Name  
*Specialty  
*Practice Street Address  
*City  
*State  
*ZIP Code  
# of Physicians in Your Practice
Is this a private practice or are     
you affiliated with a group or
healthcare system?
How many offices are affiliated
with your practice?
How did you hear about us?
PatientPoint®
5901 E. Galbraith Road, Suite R1000
Cincinnati, OH 45236
p) 800.284.8314
f) 800.238.0348
e) LearnMore@PatientPoint.com




Moving Your Practice?

Moving Your Practice?

Contact us and we'll take care of installing your PatientPoint program in your new office.

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Make Every Minute Count

NHIA Award

With our award-winning programs, 8 out of 10 patients learned a health tip they could take action on right away. Are you getting the most out of every minute patients are in your care?

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