Medical Billing Abuse Focus Group Registration Form
Date: April 15, 6:30-8 PM
By completing the form below, I consent to the following:
I understand that the results of the focus group will be used to advocate with lawmakers for improved consumer protections for New Yorkers. This may include summaries of the comments made by participants and actual quotes of some comments. I am aware that this session will be recorded. A consent form will be presented before the event and a Zoom link will be sent to participate. Submission of this form is consent for use of my video/image/audio and any recording. A $50 fee will be mailed to participants after the event at the address listed below.
Please note that limited space is available and we may close registration to people who wish to attend if we get enough registrants. Therefore, we depend on your attendance if you register. You will only be contacted if you are selected for the focus group.
If you must cancel, we would appreciate you letting Heidi Siegfried know at email@example.com or (917) 251-4981 at least 48 hours in advance so that we can contact other potential attendees. Thank you.