Subscribe to the Hospital/Nursing Utilization Report

District 11 Hospital and/or Nursing Home Utilization Report Subscription Form

Your subscription includes:

One (1) Annual Comprehensive Report for the calendar year
Monthly access to hospital and/or nursing home utilization data

For subscription information, please contact us at:

Phone: (305) 592-1452

Email: Healthcouncil@healthcouncil.org

MM/ DD/ YYYY

Business Name

Department

Name (Full Name)

Phone

Subject

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Confirm Email

Your Subscription Includes: - One (1) Annual Comprehensive Report for the Calendar Year - Access to Monthly Hospital Utilization Data

Payment Options *

**Please specify one form of payments and a Customer Service Representative will contact you shortly to finalize your subscription.**

Checks Please make checks payable to Health Council of South Florida:
7875 NW 12 Street, Suite 118, Miami, FL

Credit Card American Express, Discover, MasterCard, Visa, accepted.
**Billing Address must match address listed above**

** IF PAYING BY CREDIT CARD PLEASE PRESS SEND BEFORE MOVING ON TO THE PAYPAL PAYMENT SECTION BELOW. PLEASE BE ADVISED THAT THE BILLING ADDRESS MUST MATCH ADDRESS LISTED ABOVE **