Business Associate Agreement Form

Business Associate Agreement

Use this form to request a signature on this business associated agreement from a new community partner. Once you submit the form, an email will be sent to the recipient requesting their signature. Once they have signed, it will be forwarded to the CEO for approval.

Today's Date*
MM slash DD slash YYYY
Business Associate Agency Name:*
Business Associate Email:
Business Associate Contact Name:
First Last
Name of Authorized Agent from Elite Recovery to whom Business Associate Reports:
First Last
Description of Services Provided by Business Associate:*

Business Associate Agreement Form

Business Associate Agreement

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