New to Billing? Sign up here.

Thank you for your interest in Medinet Medical Billing. Please complete the form below and we will contact you for further information.

All information entered is kept confidential and will not be shared with third parties.

Practice Details

Fields with a * are required

Practice name
Specialty *
Address 1
Address 2
City *
Postal code
Telephone *

Personal Details

Last name *
First name *
MSP number *
Payee number
Email *

Contact Details (if different from above)

Contact person:

Fields with * are required


Send info to Medinet             Start over