Center of Excellence

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Practice Referals

Histologics LLC receives inquiries from patients looking for practices/colposcopists who are using the minimally invasive fabric based/brush biopsy approach. With your permission, we would appreciate you completing a form so you can consent and we can refer patients seeking care to you and your group providing "Compasionate Colposcopy". We will list the compassionate colposcopists and centers on our "Centers of Excellence" page for the convenience of the patient(s) seeking care.

Full Name

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Company Name

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Work Email

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Work Phone

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Preferred Contact Method

Phone

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Who Are You?

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Subject

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Short Message

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Are you Human?(*)

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* If you submit you name or practice on our Center of Excellence form, then you agree that we may publish your contact information, together with your name and any logo that you upload using the form, on this website [and on any successor website that we may operate], on such page and in such position as we may determine in our sole discretion. You further agree that we may edit the contact information and publish edited or partial versions of the contact information. . You may terminate this licence by giving to us 30 days' written notice of termination. Thank yoju.