Group Size Change Form

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Group Size Change Form

Group Size Change Form

Complete the following fields to notify CoOportunity Health if your group size changes. You may submit a change throughout the year by resubmitting this form. We will reach out to you if there are any issues processing this update.

General Information*

Company Name:
CoOportunity Health Group Number:
Federal Tax ID:
Number of Employees:
Size is Current as of What Date?

Contact Information*

Name:
Job Title:
Phone Number:
Email:

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