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. 
  • Finally, we will plan your onboarding:
    • Activate your HIPAA Compliant Patient Portal - Welcome Email with Username / Password to follow. 
    • Training #1 - Review the model: how to submit Rx's and collect Sleep Test Results.
    • Doctor / Team Sleep Testing - complimentary sleep tests for doctor(s) and 50% discounted sleep tests for your team (limited to 2 at a time and up to 5 total), as a mutually beneficial learning experience.
    • Training #2 - Review your doctor(s) and team member(s) sleep test results with our team. 
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
Doctor Name *
Doctor Name
Anticipated Monthly Volume of Sleep Tests *
Dental Sleep Medicine Experience
Dental Sleep Medicine Training
Available Packages