PROCEPT WATER IV

WATER IV Clinical Trial Reimbursement Support Program

 

New Office Enrollment Form

CLICK HERE to complete a Business Associate Agreement (BAA) with your enrollment.
If you’re not able to complete a BAA, please contact us at PCAARC@priahealthcare.com or by phone at (860) 266-4274.
Provider Enrollment - Procept Water IV

Portal User Information

User Contact Name
User Contact Name
First
Last

Practice Information

Practice Address
Practice Address
City
State
ZIP Code

Physician Information

Facility/Hospital Information

Facility/Hospital Address
Facility/Hospital Address
City
State
ZIP Code

Onboarding Call Availability

Please select your timezone:
Time EST (Option 1)
Time EST (Option 2)
Time CST (Option 1)
Time CST (Option 2)
Time MST (Option 1)
Time MST (Option 2)
Time PST (Option 1)
Time PST (Option 2)

 

PROGRAM SUPPORT:

MONDAY–FRIDAY 8:30AM–5:00PM EST
PHONE: 860-266-4274  FAX: 860-321-1442
EMAIL: pcaarc@priahealthcare.com