Community Connections: Linking Primary Care Patients to Local Resources for Better Management of Obesity
Contact Information for Caring Family Medicine Associates | |
Project Champion Name & Role in the Practice |
Physician/Clinician Champion Name & Role in the Practice |
The best day and time of day to contact me is: ________________ | When the clinician is most available for a quick phone call meeting: ________________ |
Best Office Phone: Cell Phone/Text: Email: Fax: Other: Of the above, the preferred way to contact me is: ________________ |
Best Office Phone: Cell Phone/Text: Email: Fax: Other: Of the above, the preferred way to contact the clinician is: ________________ |
The best back-up person to contact is: ________________ Contact number/Email: |
Regular time for all-staff meetings: ________________ Day/Time: |
I prefer the following method for receiving information/materials for myself or office/patient distribution:
Email: |
Please copy me on Emails to the following individuals in this office: ________________ |