Remember to include your name and contact information, and the name of your practice/agency. For security purposes we will only send the Login ID and Password to the fax number or email address we have already registered to your account.

Region	Select New York Florida
Reason for Contact	Select Create User Name/Password for Online Account Forgot User Name & Password Update My Account Apex Mobile Apex Web Scheduler Request Forms Supplies Other
Your Name (first and last)
Your Email Address (your company email if applicable)
Group Practice or Agency Name  (if applicable)
Health Care Provider Name (MD, ARNP, PA)
Health Care Provider NPI
Apex Account# (if you are unsure, leave blank)
Business Address (if multiple locations, also include those additional addresses, phone #'s and fax #'s)
Business Phone#	() -
Business Fax#	() -
All Additional Providers in Practice (Names and NPI's) (if applicable)
Additional Comments or Questions
Please verify	Get a new verfication code Write the characters in the image above
	*Please note: Login details will not be provided via email to non-corporate email addresses. A temporary password will be faxed to the fax number Apex has listed to your account.