PPPS Membership Application Form

Private Practice Physicians Section Membership Application
The Private Practice Physicians Section (PPPS) seeks to preserve the freedom, independence, and integrity of private practice so that physicians who chose to practice in that setting can provide compassionate, caring, personal medical care for their patients.

Membership in PPPS is open to any AMA member in a physician-owned private practice, which is defined as a practice in which physicians, in the aggregate, own a controlling interest.
Personal information

First NameLast Name
Email
example@example.com
Phone number
Practice information

Please provide information about your practice.
Practice name
Practice address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice specialty or specialties
Number of physicians in practice
Do the physicians in your practice, in aggregate, own a controlling interest in the practice?

Other
Should be Empty:

Private Practice Physicians Section Membership Application