New Mexico's Health Quality Improvement Organization

Request more information on Alternative Dispute Resolution

Please check the box that best describes how you would like to receive information:

	Email			Fax
	Regular mail			Phone call

I am a physician or health care provider I am a beneficiary
Name:

Title:

Address:

City:	State: Zip Code:

Phone:	Fax:

Email:


Please enter any comments and/or questions in the box below: