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Crowdsourced Provider Access
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Healthcare Organization Sign Up
Legal Name of Healthcare Entity:
(Used for your public profile)
Type of Organization:
(Click all that apply to your organization)
Hospital / Health System
Doctor Office / Medical Group
Ambulatory Surgery Center
Home Health Provider
Number of Providers:
(All providers, including Mid-Levels, that bill through the organization)
By checking the box and clicking “Sign Up” you represent that: (1) you have read and agree to the Apaly Health Platform Terms of Service Agreement, and (2) you have the right, authority and capacity to enter into the
Apaly Health Platform Terms of Service Agreement
on your own behalf, and on behalf of the healthcare organization you have entered above, as applicable.
You must accept the terms in order to continue.
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