Sign Up Is Easy
For businesses we ask that you fill out the form below titled Employer ACH Authorization. This should be filled out by someone with signing ability for the bank account that the monthly payments will be drafted from. We then ask that you forward the link titled PWC Employee New Patient Packet to your employees to have them fill it out. If there are any questions please call Jason Adragna at 970-765-0287 or email him at firstname.lastname@example.org.