Registration Page

Registration

To register for future participation in patient surveys DMD conducts, you must provide your name and address below.

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•           Name:        Address 1:        Address 2:             City:            State:         Zip code:     Phone Number:  (optional)  E-mail address:    

  
  

Once we have this information from you, DMD will send a Patient Panel Enrollment Packet. It contains general information about becoming a member, plus a survey form for you to complete and return concerning your use of prescription medications.

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