Account Set-Up

EMPLOYER ACCOUNT SET-UP

Set Up Your MedScreens Business Account

Complete the secure five-step form to provide your company information, authorized contacts, billing details and testing needs. Our team will review the submission and contact you about the next steps.

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Before You Begin

Have company and billing information ready
Identify authorized company contacts
Allow time to complete all five steps
Review entries before submitting

WHAT TO EXPECT

A Simple Account Review Process

Complete the Form

Provide the requested company, contact, billing and service information.

MedScreens Reviews It

Our team reviews the information and contacts you if anything else is needed.

Receive Confirmation

We will explain account approval, payment arrangements and how to request services.

Account approval: Submitting this form does not automatically approve charging privileges. Payment is required at the time of service until MedScreens confirms that your company has been approved for account billing.

SECURE ONLINE FORM

Begin Your Account Set-Up

Required fields are marked with an asterisk. Use the Next and Previous buttons to move through the form.

Account Set Up

Step 1 of 7

Company Information
Company Information
Company Name*
Physical Address*
Street Address Address Line 2 City State ZIP Code
Is the Billing Address the Same as the Physical Address.*
- Yes
- No
Please note that your company must be pre-approved prior to being allowed to charge on your account. Payment will be required at the time of service until your company is pre-approved for charging. You may arrange payment over the phone, pre-pay online at our website or make other payment arrangements prior to the time of service.
Billing Address
Street Address Address Line 2 City State ZIP Code
How many years has your company been in business?*
Please enter a number greater than or equal to 1.
How many employees does your company have?*
Please enter a number greater than or equal to 1.
Website

Master and Sub-account location upload
Accepted file types: xls, xslx, Max. file size: 128 MB.

If you have more than 10 locations, please Download and Complete our Multiple Location Spreadsheet. Upload here or eMail the completed form to (Info@MedScreensInc.com).
Sub-Location #1
Sub-Location #1 Contact
First Last
Sub-Location #1 Phone
Sub-Location #1 Fax
Sub-Location #1 eMail
Sub-Location #1 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #2
Sub-Location #2 Contact
First Last
Sub-Location #2 Phone
Sub-Location #2 Fax
Sub-Location #2 eMail
Sub-Location #2 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #3
Sub-Location #3 Contact
First Last
Sub-Location #3 Phone
Sub-Location #3 Fax
Sub-Location #3 eMail
Sub-Location #3 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #4
Sub-Location #4 Contact
First Last
Sub-Location #4 Phone
Sub-Location #4 Fax
Sub-Location #4 eMail
Sub-Location #4 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #5
Sub-Location #5 Contact
First Last
Sub-Location #5 Phone
Sub-Location #5 Fax
Sub-Location #5 eMail
Sub-Location #5 Physical Address
Street Address Address Line 2 City State ZIP Code
Do you have more locations?
- Yes
- No

Sub-Location #6
Sub-Location #6 Contact
First Last
Sub-Location #6 Phone
Sub-Location #6 Fax
Sub-Location #6 eMail
Sub-Location #6 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #7
Sub-Location #7 Contact
First Last
Sub-Location #7 Phone
Sub-Location #7 Fax
Sub-Location #7 eMail
Sub-Location #7 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #8
Sub-Location #8 Contact
First Last
Sub-Location #8 Phone
Sub-Location #8 Fax
Sub-Location #8 eMail
Sub-Location #8 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #9
Sub-Location #9 Contact
First Last
Sub-Location #9 Phone
Sub-Location #9 Fax
Sub-Location #9 eMail
Sub-Location #9 Physical Address
Street Address Address Line 2 City State ZIP Code
Sub-Location #10
Sub-Location #10 Contact
First Last
Sub-Location #10 Phone
Sub-Location #10 Fax
Sub-Location #10 eMail
Sub-Location #10 Physical Address
Street Address Address Line 2 City State ZIP Code

Need Help With the Form?

Call MedScreens during regular business hours, Monday–Friday from 8:00 a.m. to 5:00 p.m.

CALL 601-939-3030 CONTACT US