Register

Use Tab key or Mouse to advance from field to field. Use Enter key or click Create Account when form is completed

Create New Account:

Practice Name: *	Practice/Physician Tax ID: *	Select Reimbursement Method: *
	Tax ID must be 9 digits	Savings Card Control Card ID# Electronic Funds Transfer (EFT) Only one Reimbursement method may be used at a time. ALL claims will be processed using the selected Reimbursement method.
Please enter the physical address of the practice. No PO Boxes please. The practice name and address should exactly match documents listed for the physician/practice Tax ID#.

Address 1: *	Address 2:


City: *	State: *	Zip: *
		Zip must be 5 digits

Phone Number: *	Fax Number: *	Email Address: *
Phone must be 10 digits

How should we notify you that a Reimbursement has been made (Savings Card funded or EFT deposit in your bank account)? * EmailFax

Contact Information

Contact Name: *

Phone Number: *

Email Address: *

How can we best reach the contact? *

Phone

Fax

Username: *
Email: *
Passwords must be a minimum of 8 characters and contain at least one symbol character.
Password: *

Confirm Password: *

Thanks for registering! You will be automatically logged into your account. An email will be sent to the contact email listed on this registration. When you receive this email from the IOI program, please click the hyperlink to confirm.

*Required fields

Message

To order a new kit, simply send an e-mail to IOAcopayordering@pskw.com. Please include your practice name, address, phone, and contact information. Kits will be shipped within 24 to 48 hours.

Practice Not Associated.


Please select a practice for the user.

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