PHYSICIAN ENROLLMENT FORM:
Please complete the Practice Registration Form with as much information as possible. If you have not already done so please print off the Acknowledgement and Signature Form and have each physician sign and upload it at the bottom of this page.
Supplies on all new accounts will be shipped out the same day if the order is in before 1:00pm CT via overnight express shipping. Please NOTE supplies will be shipped to arrive at anytime the day after they are shipped between 9:00am and 3:00pm to the practice.
Print the Acknowledgement and Signature Form.