For Providers

How to Join

Step 1: Fill out and sign our HIE Participation Agreement

Pg 1: Practice/ProviderName

Pg 5: Sign & Date

Pg 24: Exhibit E-1

Step 2: Fill out HIE Assessment Questionnaire

Step 3: Please submit the completed HIE PA and Assessment Questionnaire forms online or via email/fax. An HIE representative will contact you to further assist you.


Fax: (714) 935-1407

For any other questions, please contact us.