No Contact Form
No Contact Form
To add a “Do Not Contact” (DNC) restriction to your AMA Physician Professional Data™ record, complete the form below and mail/fax it to the AMA at the address/fax number provided.
[pic]I wish to be a NO CONTACT
I understand I will no longer receive medically related information from medical publishers, continuing medical education providers and pharmaceutical manufacturers using the AMA Physician Professional Data as a list source.
Please enter your:
Top of Form
Legal First Name: Legal Last Name:
[pic] [pic]
Address: City:
[pic] [pic]
State: Zip Code:
[pic] [pic]
Daytime telephone number and/or Email address:
[pic] [pic]
Date of Birth: (For validation) Year of Graduation: (For validation)
[pic] [pic]
Physician Signature ________________________________________ Date: _________________
Send form to:
American Medical Association
Department of Data Management Operations
Attn: Data Verification Unit (Do Not contact)
AMA Plaza
330 N Wabash Ave, Suite 39300
Chicago, IL 60611
312 464-4880 (fax)
Due to the advance purchase of AMA Physician Professional Data for mailing purposes, it may take 90 days or more for all end-users to implement a No Contact request. As a result, you may continue to receive AMA mailings for 6-8 weeks.
Please contact the AMA’s Unified Service Center at (800) 621-8335 if you have any questions or require additional information. Bottom of Form
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