New Account Setup (Pl fill in all the details to avoid delays in processing)

Group Name (e.g. ABC Heart Center) Address Contact Details : (name/number/email)

Sites of Service : (locations : office/hospital) Name Address Type (Office|Hospital)

Individual Accounts : (email will be sent to each individual with login details) First Name Last Name EMail Phone Mobile access (Yes|No)

Define Workroups (e.. Billing, Scheduling) [Optional] :