Skip to content

Founding Agency application

Do not include patient names or any patient information anywhere in this form. CuraDefend assessments concern your organization’s practices, not patient data.

About you

Administrator, owner, DON, practice manager…

Optional

About the organization

Optional

Including part-time and contract staff

“Unsure” is a fine answer — we'll help you work it out.

Select every state where you serve patients. Hold Ctrl (or Cmd) to select multiple.

Where things stand

Spreadsheet, binder, a consultant, memory — honest answers help us help you.

A sentence or two. No patient information.

Confirmations

Submitting costs nothing and commits you to nothing. We reply within two business days.