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PHYSICIAN SIGN-UP

Doctor reviewing a patient file from Express Lab, a medical laboratory, with draw site locations in Boise, Garden City, Meridian, Nampa, Pocatello, Idaho Falls and Rexburg.

New Physician Account Sign-Up

To inquire or sign-up for physician services, there are three easy options:

  1. Call 208-529-8330 Ext #756
  2. Download and email this .pdf form
  3. Fill out the following online form

Online Physician Sign-up Form

Contact Name*
Address*

Office Information Details

Office Manager
Lead MA
Billing Contact
After-Hours Contact (Critical Results Calls)
Billing Type (check all that apply)
Patient Draw/Collection Location
Report Delivery Method(s): (Check all that apply)

Courier Pickup Schedule

Pickup Type (check one):
Standard Work Days
Standard Opening Time
:
Standard Closing Time
:

Add any unique weekly hours that differ from the above standard opening and closing time (ie closed for lunch between 12:30pm and 1:00pm daily).

Physician Information

Physician Name (1)
Online Result Portal Access
Physician Name (2)
Online Result Portal Access
Physician Name (3)
Online Result Portal Access

EMR Interface Request

An Express Lab Rep will follow-up to discuss and approve.

EMR Account Rep
Office Contact / IT Contact

Enter any other details or information.