CHIA Corporate Partner Application and Webpage Update Request

CHIA Corporate Partner Application and Webpage Update Request
If this is an update request, please review the current directory and only complete the sections you wish to update.
Company Name*
Corporate Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Include address above on the CHIA Corporate Partner Directory?*

YesNo
Corporate Phone Number
Please enter a valid phone number.
Include phone number above on the CHIA Corporate Partner Directory?*

YesNo
CHIA Contact
Corporate Partnership Contact

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
CHIA Corporate Partner Directory
Company Website (this will be listed on the Corporate Partner Directory)
Type of Business (select up to five)

Artificial Intelligence / Clinical Data Integrity SolutionsCoding and Clinical Documentation AuditsComplianceDocumentation Management ServicesElectronic Health Record ServiceseMPI/MPI Cleanup/Patient Identity ManagementHealth Information Consulting ServicesHealth Information/Data ExchangeMedical Coding / Clinical Documentation Improvement ServicesPrivacy & Security SolutionsProject ManagementRelease of Information / Health Information Access SolutionsRevenue Cycle SolutionsStaffing Solutions (Including Interim Management and Outsourcing)
Please upload THREE logos, one vector file in .ai or .eps format and another in .png, .jpg, or .jpeg. Please make sure to also include one logo that is 200 X 200 px in size.

Cancelof
If you would like a video on your CHIA Corporate Partner webpage please submit a video which is one minute or less.

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Please submit a description of the company to be placed on the CHIA Corporate Partner Directory you may include contact name, phone number with your description. (emails will not be listed)
Brief Description For Directory Listing*

0/130
Full Description (you may include a representative and their phone number in this area)
Payment Information
An email will be sent to you with a secure link to view and/or pay the invoice via credit card, other payment options are available on the invoice.
Should be Empty:

CHIA Corporate Partner Application and Webpage Update Request

CHIA Contact

CHIA Corporate Partner Directory