• Financial Disclosure & Agreement Form

  • The Financial Disclosure & Agreement Form must be completed annually by members of the medical staff who attend and participate in any of the following conferences:

    - Breast Multi-Disciplinary
    - Cardiology
    - CNS Multi-Disciplinary
    - GI
    - GI Multi-Disciplinary
    - GYN Multi-Disciplinary
    - Head & Neck Multi-Disciplinary
    - Hematology
    - Melanoma Multi-Disciplinary
    - Pediatrics
    - Renal
    - Thoracic Multi-Disciplinary
    - Trauma and any Joint Sponsored conferences

    Please complete and submit to the email address located on the form. If you have any questions, please call 719-776-5140.

    Financial Disclosure & Agreement Form  

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