Member Interest Survey
Member Interest Suvey

Great healthcare is dependent on great physicians.  When a new physician considers setting up a practice in Montezuma County it’s important that we make him or her feel welcome and at home.  In order to help with that, we want to put together a database of interests for our members.  That way when we have a physician who has a specific passion for a hobby, sport, or activity, we can immediately locate someone who can get them excited about our community.   Thank you for helping us make physicians feel welcome in our community! 

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Hobbies, sports, activities or other interests
Do you have children? What ages?:
Are there other ways you could help in recruiting physicians?:
Are there others in the community we should contact to include in the data base of special interests?:





Cortez Area Chamber of Commerce * 928 East Main * PO Box 968, Cortez, CO 81321 * (970)565-3414
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