Please sign up below to enable services for your group. If you have multiple providers in your group, please include the names and NPI numbers for additional providers. Clinic Name* Phone Number* Please enter a valid phone number. Provider Name* First Name Last Name Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Provider NPI Clinic Email* example@example.com Select Your Plan* Pay as you go ($25/consult)Unlimited Consults ($150/month/provider)Pay as you go (50% Collections) I agree to the Terms of Service and Memorandum of Understanding above* Clear Name* First Name Last Name Title* Submit Should be Empty: