Thank you for choosing to participate in the HFM Chamber Clinic. Please complete the below fields for each individual (employee, spouse, and dependents) that will be enrolling. Each participant will receive an HFM Chamber Clinic card with their name on it, that card will need to be shown at each clinic visit.
The HFM Chamber Clinic is open to chamber member employees and their families.
Please contact firstname.lastname@example.org for any questions regarding this form.