Email Distribution Addition/Deletion Form For Absolutely Health Care, Rehab Options USA, Med Options USA, And Nurse Options USA Clients.

We have set up our new system to send out newsletters, announcements, and tips by email. This will allow us to send information faster and less expensively. It will also allow us to easily distribute this information to all individuals in your organization involved in using our various services. If you would like to add or delete individuals from our list, please fill out the form below, and fax it back to us at 800-357-8684. You do not need to send this form back to us if you have filled it out previously, and/or you do not have any additions or deletions for us.

Facility/Company:
___________________________________________

Person Filling Out This Form:
___________________________________________

Title:
___________________________________________

Phone #:
___________________________________________

Please add the following people to your distribution list:

Name:                  Title:                      Email Address:

________________ _________________ __________________

________________ _________________ __________________

________________ _________________ __________________

________________ _________________ __________________

________________ _________________ __________________

Please delete the following people to your distribution list:

Name:                  Title:                     Email Address:

________________ _________________ __________________

________________ _________________ __________________

________________ _________________ __________________

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