Q

Parameters

00[Action][New]
01[WebID][]
02[Client][]
03[Password][]
04[URL][]
05[Data01][]
06[Data02][]
07[Data03][]
08[Data04][]
09[Data05][]
10[Data06][]
11[Data07][]
12[Data08][]
13[Data09][]
14[Data10][]
15[Data11][]
16[Data12][]
17[Data13][]
18[Data14][]
19[Data15][]
20[Data16][]
21[Data17][]
22[Data18][]
23[Data19][]
24[Data20][]
25[Data21][]
26[Data22][]
27[Data23][]
28[Data24][]
29[Data25][]
30[Data26][]
31[Data27][]
32[Data28][]
33[Data29][]
34[Data30][]
35[Data31][]

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New Client Account 2.88

Please fill in the items below. Required fields are in red.

Client Information
Clinic Name
Reporting Address
Street
City
State
Zip Code
Country
Phone
Billing Address
Street
City
State
Zip Code
Country
Report Results Distribution Options (select up to 2)
USPS Mail E-Mail Fax
Email
Fax
Midnight-8am 8am-Noon
Noon-5pm 5pm-Midnight
Any time Time Zone
University Accounts
MSU Campus accounts supply a valid University Ledger account #