Colorado School of Traditional Chinese Medicine

Update Contact Info

Alumni Contact Info Update Form

Please use the form below to provide us with your current information and location of practice, and be sure to let us know if you want us to list you in our Practitioner Directory.

This information will not automatically be listed in the Practitioner Directory but allows us to maintain our internal records of your contact information.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Phone 2
Additional Notes/Comments
Practitioner Directory Information
If you would like us to list you in the CSTCM Practitioner Directory, please select “List me in the Practitioner Directory” and fill out the additional form below. We will verify your request with you before adding you to or updating your listing information.
Practitioner Directory Listing Request*
Do you want to be listed in our Practitioner Directory? By selecting “YES”, we will ask for additional business information below
- Yes – List me in the Practitioner Directory
- No
Practitioner Name
First Last
Business Name
Practitioner Phone
Practitioner Business Email
Practitioner Business Website
Practitioner Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Practitioner Business Description
Do you have any treatment specialties? How long have you been in practice/What year did you get your license? What languages do you speak? What forms of payment do you accept? Cash/Check/Credit/HSA/Paypal? Do you accept insurance? In network? Provide superbills? Any other information you would like to include (practice hours, new patient payment specials, parking available, handicapped accessible)?
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Email
This field is for validation purposes and should be left unchanged.

Update Contact Info

Alumni Contact Info Update Form

Practitioner Directory Information