Clinician Signup

Please fill out the form below to create your new account. After signup, you will be sent an email with a link to confirm and activate your account.

* = Required Fields

Your Information

First Name
*
Last Name
*
Credential/Title
*
License #

Optional. If provided, this is included on each of your letters of medical necessity.

Login Information

Email Address
*

Enter your email address (you@someplace.com).

Confirm Email Address
*

Please confirm your email address.

Password
*

Minimum 8 characters.
Minimum 1 special characters.
Password is case sensitive.

Confirm Your Password
*

Please confirm your password. Password is case sensitive.

HIPAA Compliance

HIPAA Compliance
LMNBuilder.com is 100% HIPAA compliant. If there is a need to omit clients' last names to comply with your organization's internal policies, check the following:
Please omit my clients' last names.

Your Workplace

This information is used in the letters you will be creating.

Organization Name

Address

City

State

Zip/Postal Code

Country

Can you use this in a country outside of the U.S. or Canada? Please contact us.

Phone Number

Mobile Number

Fax Number

Optional, but recommended.

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* = Required Fields

Your Information

Login Information

HIPAA Compliance

Your Workplace

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