Office Enrollment Form

Please complete the form below to EnroLl your practice

  • We will also send you a Business Associates Agreement (BAA) to be completed before activation.

  • When the Office Enrollment & BAA have been received, we will activate your account within 1 business day.

  • Next, we will plan your onboarding:

    • Activate your HIPAA Compliant Patient Portal - Welcome Email with Username / Password to follow.

    • Training #1 - Model: How to complete your Rx and submit via your HIPAA compliant portal.

    • Training #2 - Sleep Test Results Review and Patient Billing Protocols: Review your doc/s & team member' results.

    • Training #3 - Patient Analysis Review & Coaching: Evaluate trends with your prescribed patients for our mutual benefit.

Please call 630-845-3483 or email if you need any assistance with the following form.

Address *
Practice Phone *
Practice Phone
Back Office Phone
Back Office Phone
Referring Clinician Name *
Referring Clinician Name
Anticipated Monthly Volume of Sleep Tests *
Sleep Medicine Training
Let us know who referred you so we can thank them for the opportunity.
Available Packages *