Welcome! This page of the website is dedicated to the wonderful professionals all across the country (and beyond) who serve our clients and customers. We've added information that is frequently requested. Please let us know if there is anything else we can include on this page to better serve you. 

Please complete and return via email, fax, or mail if your office information has changed, or you would like to add additional office locations to your exisiting practice.

To add another clinician to your practice, please complete the application and return along with copies of their license, liability insurance, and resume. 

Note: Adobe Acrobat Reader is required to view application materials.
Click on the link below to download a free version of Acrobat Reader. 
http://www.adobe.com/products/acrobat/readstep2.html

Please note for application submission:
You cannot save data typed into the form. Please print your completed form and submit via fax, mail or scan into a PDF document for e-mail submission or you can print the forms out and complete information in legible hand writing for submission.