Create Account
Below, please enter the requested information. Also, please provide an email address so we can send you your login information. When you've finished, click the [Create Account] button at the bottom of this page.

  Required fields are indicated by a red asterisk(*) and bold lettering.
Facility Information
The facility is located:*  
Organization Legal Business Name:*      
   
   
Federal Tax ID: xx-xxxxxxx *
Have a Canadian Business Number?
   
Phone Number: xxx-xxx-xxxx *  
   
Street Address:*    
Street Address 2:
City:*    
Province/State/Region:*      
Postal Code:*      
Country:  
Testing Modality
Which testing modalities is your facility currently applying for?* Diagnostic:







Therapeutic:



Email Address
Please enter the address where you'd like us to send your login information and Account ID.
Email Address:*     


After logging into the Online Application using the temporary account User ID and Password you must follow the instructions/link on the main page to create an application administrator for the account. All application administrator/log in information will be sent to the provided email address