Client Onboarding

This form collects the information needed to set up billing and revenue-cycle services for your pharmacy. Please keep a copy of the confirmation email you receive. You can leave at any time and resume from a link we email you.

Provide contact information for each of the core roles below. Passwords must NOT be provided on this form.

SECURITY NOTICE: Do not write passwords on this form. Secure credentials should be transferred through the agreed secure method.

Aged Accounts Receivable Breakdown

SECURITY NOTICE: Do not provide passwords on this form. Use client-created individual users, portal invitations, or another secure access method.

I certify that the information provided in this onboarding form is accurate and complete to the best of my knowledge. I understand that incomplete or inaccurate information may delay implementation or affect billing and revenue cycle performance.