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Obesity Data™ Licensing

Licensee Registration

Register your practice to review and license Obesity Data™ datasets. You review each dataset and license only what you accept. About two minutes.

Practice

Practice Name Phone

City and State

Electronic Health Record (EHR) System IT Contact (Name, Phone or Email)

Obesity Data™ Categories

Choose the categories your practice wants to license. You can add a category later.

Patients Who Qualify for GLP-1Patients Who Qualify for Telehealth Services

Contact

Name and Title Email

Introduced By

Commissioned Representative (Optional) Rep ID (NCH-R-____) (Optional)

Certifications

The practice provides, or is launching, telehealth services. Neither the practice nor its clinicians is excluded from any federal health care program (OIG LEIE or SAM.gov). I am authorized to register the practice, and the practice will sign the NCH Obesity Data™ License Agreement before any dataset is licensed.

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