Provider Network Sign-Up | PN Testing Agency

Please provide the information below. After reviewing, a member of our team will send you a User Invite that will allow you to sign in to the Provider Network to update your listing and notification settings.

First Name (of contact filling out this form):

Last Name (of contact filling out this form):

Email (of contact filling out this form):

Role (of contact filling out this form):

Do you want your company to be listed on the network as:
* Public - Any agency using Orchid JMS can find this provider by searching or browsing the Network.
* Private - This provider never appears to agencies browsing the Network in Orchid JMS. Any agency that wishes to connect to this provider must manually request to do so.

What do you want your Participation Level to be?
* Participating - This provider actively uses the Provider Network application. It can send and receive agency requests and documents, and agencies can share match sheets and cycles. In-system and email notifications about activity can be customized for provider users in their "My Account" section.
* Passive - This provider has claimed and updated their record, but does not intend to actively exchange case information. Provider users can log in to view their listing and shared case information, but it can not send nor receive agency requests. In-system and email notifications about activity can be customized for provider users in their "My Account" section.

Please provide the following up-to-date information about your company.

What Provider Type most accurately represents your company?

Company/Provider Name:

Branch Name (specific facility name or specific location, if applicable):

Website:

General Contact Email:

General Phone Number:

Country:

Street Address:

Street Address 2:

City:

State/Province:

Zip Code:

Thank you for your interest in the Provider Network by Orchid Software Solutions.

You will receive an email from [email protected] with an invitation to set up your User Account. Once you have signed in, you will be able to add or update details such as a summary, your service area, and services provided and update your Notification Preferences, as well as edit Contacts (a list of individuals that the agency users will be able to see), and invite additional Users (people who can login to see cases and update your listing.)

Please reach out to [email protected] with any additional questions!