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For Providers & Institutions

General Inquiry

Use this form if you are a provider, practice manager, or institution exploring CareMedox, or just generally want to reach out for information.

Your Full Name*

Practice / Organization Name*

You are a

Specialty / Type of Practice *

Collection *

NPI (if applicable)

Phone Number *

Email Address *

Website

Referral Code

Address / Location

Message / Inquiry Details *

Your Voice Matters

Share Your Feedback/Review OR Register a Complaint

Submit a complaint or feedback / review — whether you are a client, provider, referring partner, or our employee.

You Are *

Practice / Organization / Department Name *

Contact Person Name *

Role / Title *

Email Address *

Phone Number *

Complaint / Feedback Type *

Additional Details / Message *

Upload Supporting Document for Complaint OR Your Image for Review / Feedback (Optional)

Click or drag to upload (PDF, DOC, PNG, JPG)

Explore Our Solutions

Request Services

Use this form if you are selecting a particular service (e.g. medical billing, RCM, credentialing, audits, patient calling, etc.) or want to send service-related offers, contracting, or request more details about a service.

Practice / Organization Name *

Contact Person Name *

Role / Title *

Specialty / Type of Practice *

Collection

NPI (Your or Your Facility) *

Phone Number *

Email Address *

Website

Referral Code

Location / Address

Offers / Proposal Details / Message *

Refer & Earn with CareMedox

Referral Form

If you would like to join our Referral & Earn Program fill below form or if you are already enrolled and wish to submit provider information for new referral submission—please complete New Referral submission form below this Join Our Referral Program form.

Join Our Referral Program

Full Name *

You are *

Phone Number *

Email Address *

Website (Optional)

How did you hear about CareMedox? *

Choose Earning Model *

If you're unsure, click here to learn more—then return to select the right option.

Enter Your Address

Describe about yourself or any message for us *

By Submitting, I agree to CareMedox's Terms, Conditions and Policies regarding the Referral Program. I hereby confirm that all the information I am submitting is true and accurate to the best of my knowledge. I understand that I am responsible for any information that is found to be incorrect or misleading.

New Referral Submission

Referral Partner Name *

Referral Code *

Email Address *

Phone Number *

Practice / Organization Name *

Healthcare Professional Name *

Contact Person Name *

Meeting Person Role *

Specialty / Type of Practice *

Collection

NPI (Your or Your Facility) *

Phone Number *

Email Address *

Referred Party Website

Facility / Practice Address

2nd Address

Interested Service(s) *

Professional Billing Institutional Billing RCM / Revenue Cycle Management Credentialing / Provider Enrollment Audit Services Patient Calling Services RPM / Telehealth Billing Home Health / Urgent Care Billing Other — please specify in below message box

Detailed Message *

Please provide details about the physician or healthcare professional you are referring, including the preferred method for CareMedox to reach them and schedule a meeting, which will be arranged with both you and the healthcare professional present. Additionally, include any important information that CareMedox should know before the onboarding meeting, such as practice location, credentialing status, or special requirements. Finally, specify who will be signing the contract with CareMedox, whether it is the physician directly, the facility owner, an assistant, or the practice manager.

By Submitting, I agree to CareMedox's Terms, Conditions and Policies regarding the Referral Program. I hereby confirm that all the information I am submitting is true and accurate to the best of my knowledge. I understand that I am responsible for any information that is found to be incorrect or misleading.

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Contact Us

General Inquiry

Share Your Feedback/Review OR Register a Complaint

Request Services

Referral Form

Join Our Referral Program

New Referral Submission

What Happens Next?

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