System Information

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Office Ally Representative

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Provider/Group Information

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Group Providers

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Individual Providers

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Credit Card Processing Utility

OneHealth Port Users

Currently enrolled OneHealth Port users check the box below, and fill in your OneHealth Port User Name.

In order to receive your new account information quickly, please fill out and fax or e-mail back the Authorization Sheet located on the screen after you click the SUBMIT button below.

Your information has been successfully submitted.

Your next steps:

	1. View and print the Authorization Sheet, Practice Mate Agreement, EHR agreement here
	2. Initial and sign the indicated locations
	3. Fax the Authorization Sheet to Office Ally at 360.314.2184

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