Practice Expression of Interest (EOI)
Complete to express your interest as a practitioner or a practice in having MyDocPay at your practice. Note we are pre-market and still piloting our product, but we are still open to adding practices to participate in this.
Name of your practice
Your Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Practice
Please Select
GP
Specialist Consulting
Allied Health
Mixed Practice
Total Number of GPs/Health Providers
Current Billing
Private Billing
Mixed Billing
Bulk Billing
Best Way To Receive Information
In Person
Email
Phone Call
Please verify that you are human
*
Submit
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