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Marketplace Vendors

Please work with your Accuro contact to fill in the below intake form. You must fill in the form on behalf of your client, with no exception.
We recommend taking a phone or video call with them in order to gain the correct information.


*All fields required

Onboarding Provider Details

Note: These are the Providers that the clients want individually set up. Do not simply say �all� as each name and office location are necessary.

User Details (Required)
First Name *
Last Name *
Email Address *
Accuro Office Name *
?
Add / Remove Rows

Clinic Administrators

These are the main clinic contacts who we reach out to for clinic onboarding.

Training Contact (Required)
First Name *
Last Name *
Phone
Email Address *
Add / Remove Rows

Type of Users (optional)