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Strategic Partners Inquiry Form

Thank you for your interest in the establishment of a strategic relationship to help us bring our health care professional clients those services that will help them establish and maintain their practices.

We firmly believe that the scope and complexity of the issues and challenging health care professionals needs the services of organizations that are committed to these needs and we welcome your inquiry.

To initiate this process please share with us the information requested below and indicate how you would prefer to be contacted.

Name of Firm:*
Primary Business Services:*
Web site address:
Primary City/State of Operation:*
Additional State Locations:
Year Established:*
Please list any memberships with any health care associations or organizations:
How did you learn of InsMed ?
Approximate number of health care institution/practice clients:*
Approximate number of health care professional clients:*
Contact Information
Direct Dial Telephone Number:*
Name/Contact of Assistant:*

Security Code * Enter the word in image into textbox