The purpose of this form is to assist the staff at QMC to properly and efficiently set up your organization's account. Please answer each question pertinent to your organization's operation. If you have questions please contact Gary Harvat or Ed Marasco at 1.800.901.1155 and we will be glad to assist you. Thank you for your cooperation and assistance during this onboarding process.
Please provide a list of all facilities your organization currently services. Please indicate facility type (e.g., acute care hospital, skilled nursing, etc.) address and main phone number. Please provide to us in XLS (Excel) or CSV format and UPLOAD using the button below.