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Please provide the legal name of the institution, company, or other entity that will appear on the contract

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Who should be contacted for follow ups?

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In a few sentences, please provide a description of the AMA content you wish to use

Was this a printed publication, online publication, web site link, etc

What is the other source of content? Please provide as much detail as possible

Please provide the name of the requested content ("CPT Professional 2021")

Please provide the author name of the requested content (eg. Rondinelli, R.)

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Please provide the URL to the requested content (eg. or use 'n/a' to indicate that this content will not be available online

Please provide the specific quotation(s), chapter name(s), article title(s), page number(s), image(s), table(s) or other AMA Content proposed to be used

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Please describe the proposed usage type or use 'n/a' if described above

Use '0' if not web-based

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Please provide all that apply: Author, Title, Chapter or Article title, Edition/Volume, Copyright Month and Year, Publisher, URL

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The maximum length of use is 3 years

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Please select the primary use of your proposed content

Please provide the cost to the student for the class or 'n/a' if none

Please provide the cost to the student for the class materials; enter zero if none

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Note: Permission cannot be granted for usage of material that is not copyrighted by the American Medical Association. Requests for permission are granted at the AMA’s sole discretion. No permission is granted unless and until you receive a written permission letter from the AMA.

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