SUBMIT YOUR PATIENT LIST ONLINE

This list is a log for you to document the members you have enrolled and keep up with the memberships you have issued.  The list coincides with the numbers on the cards.  As you distribute cards, write the patient’s name beside the corresponding membership number.  The list will also be helpful when you receive your “Provider Quarterly Report” (a report that lists your patients, their membership numbers, addresses, phone, and expiration dates.  The list will need to be reviewed by the primary person responsible for PCD and returned to the office for any corrections or questions.)

Before you issue your last card number on the list, you should notice an asterisk with a notation reminding you to re-order materials

PATIENT LISTS AND CORRESPONDING PATIENT ENROLLMENT FEES MUST BE SUBMITTED TO PCD BEFORE YOUR NEXT ORDER WILL BE PROCESSED.

Clinic Name:

4-Digit PCD Provider Number:

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Thank you for supporting our efforts in making quality chiropractic care available and affordable for everyone!