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Practice Intake Form

Thank you for choosing TurnKeyMD! To get started, please complete this form and fill in all required fields. If you have any questions or need assistance, feel free to reach out to our customer support team at [email protected]. Once you've finished, click the "Submit" button at the end of the form. Next steps? We will send you our Service Agreement and Business Associates Agreement. Thank you for choosing TurnKeyMD to optimize your practice's communication. We look forward to serving you!

First Name

Last Name

Legal Business Name (as it appears on IRS Tax Return)

Tax ID

Practice Type

Solo Practice

Group Practice

Hospital

Others

Practice Specialty (e.g family medicine, pediatrics, cardiology, etc.)

Practice Website

Practice Main Physical Address (as Published on Google Business)

Practice Main Phone Number

Authorized Signer Name

Authorized Signer Phone Number

Authorized Signer Title

Form submission[]

Practice Intake Form

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