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QuickPayNET Provider Registration - IMPORTANT! READ BELOW BEFORE YOU ENTER A BILL

Registration Can Only Be Done Once and Should Be Done By The Practice Manager

REMEMBER YOUR USER ID, PASSWORD AND PIN! Please complete the information below.

AFTER REGISTRATION YOU MUST SIGN IN AND GO DIRECTLY TO: "ENTER/UPDATE PRACTICE INFORMATION" AND ENTER YOUR PAYTO INFO, PRACTICE LOCATION INFO AND TREATING PROVIDER INFO BEFORE YOU CAN ENTER A BILL!

Your User Name must be at least 5 characters long. Thank you for registering with QuickPayNet. As a Provider, the information that you enter concerning your practice will be checked and verified.

First Name*
Middle Initial
Last Name*
Suffix
Create a User Name*
(five character minimum)
Create a Password*
(eight character minimum must
include both letters and numbers)
Confirm Password*
Create a PIN*
(four character minimum)
Confirm PIN*
Email Address*
Confirm Email Address
Office Zip Code*
Office State/Territory*
Password Hint Question*
Password Hint Answer*