Does this practice have more than one location? *      Yes      No

The primary contact email address and password above will be used to log into the IDOC website.
Passwords should be at least 8 characters and have at least one uppercase letter, lowercase letter, number and special character.
By providing the above e-mail address (the “Secure Email”), the member, listed above, (“Member”), consents to IDOC, LLC, a Connecticut limited liability company (“IDOC”), sending potentially sensitive and confidential practice related information of Member, including, without limitation, financial information (i.e., revenue figures, sales numbers, accounts receivable collection rates, rebates received, etc.) to the Secure Email without encryption. Member is solely responsible for safeguarding the username and password for the Secure Email to prevent unauthorized access to information sent to the Secure Email. Member acknowledges that internet communications, including e-mail, are not completely secure, and it is possible that a third party could gain access to such communications. The provision by IDOC of information or recommendations to Member is subject to the IDOC Membership General Terms and Conditions in effect from time to time, which are available on IDOC’s website.