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.

Your Name
Practice/Agency Name
Email (optional)
Phone	() -
Region	Select New York Florida
Reason for Contact	Select Forgot User Name & Password Update My Account Apex Mobile Apex Web Scheduler Request Forms Supplies Other
Comments
Please verify	Get a new verfication code Write the characters in the image above