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Practice Makeover Application

Please complete all required fields below.

IMPORTANT NOTE: All applicants must have a practice in LA County, be a current LACMA member and a physician in good standing with no legal liabilities, judgments, liens, or medical board investigations.

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Do you agree to site visit(s) from LACMA?
Do you agree to share information on how grant funds were used?
Do you agree to allow LACMA to capture impact through filming and videotaped interviews?
Do you agree to a 90 day follow up assessment?
Have you received a Practice Makeover grant before?
If yes, what quarter?
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