Nominate a Provider

HMAA is committed to superior customer satisfaction. We would like to receive referrals from you regarding providers with whom you have a good relationship and who deliver excellent care. If you know of a provider who is not in our network and may be interested in participating with HMAA, please complete the form below. To expedite the nomination process, you may also ask the doctor to contact HMAA.

Please check our Provider Directory to verify that your doctor does not participate with HMAA prior to submitting a provider nomination.

We will contact submitted providers about joining our network. Please note that submission of this form does not guarantee that he/she will be added to our network. **

Please provide us with the following information. The * designates required fields.

Provider or Clinic Name:*
Provider Specialty:*
Address
Street Address City State / Province / Region ZIP / Postal Code
Your Name:*
Your Telephone Number:*
Your Email Address:*
Comments or Questions:
Please enter the security code in the image below
** Please note that we cannot approach or contract with all nominated providers. The following are some example of this limitation:
- Providers must meet all credentialing and quality guidelines.
- We may not be able to contract with a provider due to exclusivity provisions in another agreement.
- Providers generally must have admitting privileges to a contracted hospital.