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 *

Fax

Personal Details

Last name *

First name *

Initials

MSP number *

Payee number

Email *

Contact Details (if different from above)

Contact person:

Telephone:

Fields with * are required