Add My Doctor

If you really like the doctor you already have, others may as well. We love to bring good doctors to our members, so please feel free to complete the form below and we’ll get in touch with your doctor’s office.

We’ll make every effort to add the doctor or other healthcare provider to our network, subject to their meeting the demographic needs of our network and/or our credentialing standards.

Add My Doctor

Your Name*
First Last
Your Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Phone
Your Email*
Are you a (please select one)
Doctor/Healthcare Provider Information
Provider's Full Name
Facility Name
Provider / Facility Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Provider / Facility Phone
Provider / Facility Fax
Attach a form
Accepted file types: pdf, doc, docx, Max. file size: 2 MB.

Find A Doctor

Please fill in at least one search criteria!

Add My Doctor

Add My Doctor

Doctor/Healthcare Provider Information