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Agent Form - HCO or PSI Sign Up
After completing the form below, the account will be created and the HCO/PSI will be contacted with further instructions.
Agent Name:
Are you signing up an
healthcare employer
or a
post-secondary institute
?
Choose One...
Healthcare Employer
Post-Secondary Institute
Please complete all fields below for the company you are signing up:
Contact Name:
Company Account Name:
This field is for how the account name will show up on their HCO account (ex. S.R. Group - Windsor, S. R. Group - Head Office)
Email:
Phone number:
Address:
City/Province:
Postal Code:
Additional Notes:
Thank you!
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To fill out the
Invoicing Form for paying clients
, click the button below.
Invoicing Form
