Please click the link below to download the fillable PDF.

If you do not have Adobe Reader installed, please follow the instructions below:

• Download Adobe Reader here: https://get.adobe.com/reader/
• Once installed please download application and fill out
• Email the completed form to lenoraj@nrdci.com

QHC APPLICATION FILLABLE

If you cannot use the fillable version please download, print, and complete the application. Upon completion, please scan and email the complete packet to lenoraj@nrdci.com or fax to (505) 726-0202.

QHC APPLICATION PRINTABLE

If you have any questions on the application process please call (505) 726-0200.