7860 Myers Lake Avenue, Rockford, MI 49341 ||  CCM is a 501(c) non-profit Christian Corporation

Doctor Registration

Please fill out this short form to register as a donating doctor.  We will contact you within two weeks to further discuss your involvement.  Thank you - you are an answer to prayer!

First Name

Last Name

Title

Area(s) of Practice

Years of Practice

Phone

  -

  -

E-mail

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