Sign Up to Be a Nurse Practitioner Preceptor

If you’d like to learn more about being a Regis nurse practitioner preceptor, please complete this form and a staff member will be in touch.

First Name

Last Name

Best Contact Email Address

Best Contact Phone Number

Site Name

Site Location (City and State)

What Specialty Area do you Work in?

Adult Gerontology Acute Care

Adult Gerontology Primary Care

Family Primary Care

Pediatric Primary Care

Psychiatric Mental Health

Women's Health

Other

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