NHCI HC Communications and Marketing Contact Form

National Hypertension Control Initiative (NHCI) CONTACT INFORMATION Form

for Communications & marketing contact at community HEAlth Center
Please complete this form with the name and contact information of the best person in your health center location to receive Communications & Marketing materials from NHCI.
Full Name*

First NameLast Name
Email
example@example.com
Organization Type*
Health Center Name
Please enter the details of your Community Health Center (FQHC) since it was not found in the dropdown list...
Health Center Name (manually added)
City
State
Zip Code
BHCMISID
Bureau of Primary Health Care Health Center Management Information System ID
Please identify your primary role at your Community Health Center (FQHC)
The information collected will be used to provide NHCI information and materials.
Contact nhci@heart.org if you have any issues with registration.
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