OCM Portal

Please Note

All Providers nominated must meet OCM's contracting criteria and eligibility requirements to receive an application to the network. One Call Medical may not be developing a particular market at the time of your nomination. However, your input is valuable and your nomination will be kept on file for future use.

All fields in the form are required before you can submit.

Your Information
First Name:
Last Name:
Company Name:
Phone:
Fax:
What employer:
Type of Provider
Neurodiagnostic Provider (EMG/Nerve Condition Study)
Physician Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Radiology Network (MRI/CT)
Facility Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Comments:

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