Email Address:{{}}
First Name:{{validationState.firstname}}
Last Name:{{validationState.lastname}}
Password confirmation:{{validationState.passwordconfirm}}
Phone number:
What are the names of clinic(s) associated with your organization?
  • A 'clinic' can be any clinical entity, including an outpatient clinic, a community pharmacy, or an inpatient unit.
  • If you only registering one clincal entity, your clinic name can be the same as your organization name.
  • Please only list the names of the clinic(s) you want added to the tool. There are the clinics for which you will be documentintg MTPs.
Please list the names and email addresses of the user(s)/pharmacist(s) you would like added to each clinic within the tool.
  • Please list the users by clinic so that they can be entered into the system correctly.
  • If you would like any user/pharmacist to be assigned to more than one clinic, please list them under each clinic for which they will be documenting MTPs.
What are your reason(s) for wanting to use the tool? (check all that apply)
Which of the following best describes the type of clinical setting within which you will be documenting MTPs?
Additional Comments

Thank you! You have successfully signed up to use the CMM Patient Care Process Self-Assessment and the CMM Practice Management Assessment Tool.

An email has been sent to the address you provided with a link for validating your email. If you do not receive an email, please contact us.

If you have also requested access to the MTP Documentation Tool, you will receive a separate email when your MTP account has been activated.

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