Join us as a provider

Tell us about your practice and someone from our team will reach out. Setting up an account takes a short call — there is nothing to pay to get started.

First name

Last name

Company or practice name

Your role there

For example: Physician, Practice Manager, Office Administrator, Owner.

Work email

Phone

Specialty (optional)

For example: Family Medicine, Dermatology, Orthopaedics.

City

State

We will only use these details to contact you about joining My CheckUp Health. This form is for practices — if you are looking for care, create a patient account instead.