New Provider Registration
I have read and accept the User Attestation

By submitting the information requested in the Online Fee Schedule System, the user acknowledges and affirms that this information is true, accurate and complete and that the user has authority to access and receive the fee schedule information. The user understands that any falsification, omission or concealment of the information being requested may constitute a breach of the participating contract in place between the parties and may serve as a basis to terminate the contract as well as expose the user to personal liability if not authorized to submit or access the fee schedule information. This acknowledgement shall constitute the required fee schedule notification pursuant to the participating contract in place between the parties.

I have read and accept the Terms and Conditions for Use