Looking to get a COVID-19 immunization or a take home rapid antigen test kit? Find a participating pharmacy near you.
With tax season coming soon—find out how to obtain a Receipts of Payment and a Claims History report on our member site.
If you have more than one office, a separate request form must be completed for each office.
For offices with more than one health services provider, each person who bills under his/her own practice should complete a separate form.
(e.g. chiropractors in the same office sharing the same login ID and password)
(e.g. a single sign on for chiropractors and physiotherapists in the same office sharing the same login ID and password)
Indicate your unique login ID below.
Your login ID must contain three to fifteen letters and/or numbers and no spaces or symbols.
In order to fill out this form, you must be an authorized representative of the above-mentioned health services provider.