DME Account Registration Form
Create your account with pVerify
Please fill out the form below
Please use this DME Account Registration Prepaid Form to help us to create your account. You will receive an email from email@example.com when this is done.
Note: An NPI is required for Eligibility. A PTAN is required for Same or Similar. If you are supplying an NPI or PTAN from a US Partner or Affiliate a signed Authorization Form is required.
Thank you for choosing pVerify!
Please provide the Authorization Form provided to firstname.lastname@example.org.