Do You Need a Business Associate Agreement?

In order to be eligible to receive a Business Associate Agreement (BAA), you must complete this survey application in its entirety.

Please fill in the required information and answer the questions for your company.

Thank you for taking the time to complete this survey!

1. To get started, please enter your information below. *This question is required.

First Name

Last Name

Title

Email Address

Company Name

Customer ID (CID)

Website Address

Full Physical Address

Do you reference HIPAA on your website?

2. Is your company one of the following? *This question is required.