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Bill Office

Account Agreement 

For healthcare professionals seeking a streamlined process for billing and medication orders, we invite you to download our fillable PDF Account Agreement form. This document is designed to establish a comprehensive billing account with us, ensuring a seamless collaboration. To begin, simply download the Account Agreement form, available through the provided link. Once downloaded, please fill out the form with the required details, including physician name, clinic name, DEA number, license number, NPI number, and billing information.

 

After completing the form, kindly email it back to us at contact@ucprx.com

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