Registration – Upneeq Registration

Join UPNEEQ Find-A-Doctor today!

Sign up today to help more patients find your practice.

Instructions

Complete the fields below (* indicates a required field)
Click “Review” to confirm or edit your entries
Once all your entries are confirmed, click “Approve” to submit your form

Your data will be stored in our secure database. Once UPNEEQ Find-A-Doctor is launched, you will be notified via email.

Review

Please review your information. If you need to make changes, click “Edit”. If your information is correct, click “Approve”.

Personal Information

First Name *

Last Name *

E-mail Address *

Profile Photo

Professional Information

Degree(s)

Your NPI Number *

Specialty *

Languages Spoken *

English
Spanish
Add new choice

Practitioner Website

Telemed Services

Online Appointment Link

Office 1

Please enter your primary office address. You can add other office locations and information below. Your information will appear to patients searching by ZIP code.

Practice Name *

Phone Number *

Address 1 *

Address 2

City *

State *

ZIP Code *

Hours of Operation

	Day of the Week	Closed	Open at *	Close at *
1		ClosedOpen
2		ClosedOpen
3		ClosedOpen
4		ClosedOpen
5		ClosedOpen
6		ClosedOpen
7		ClosedOpen
1		ClosedOpen

Office 2

You can enter another office location here. Based on the ZIP code, this location may appear first in ZIP code search results.

Office 3

You can enter another office location here. Based on the ZIP code, this location may appear first in ZIP code search results.

Office 4

You can enter another office location here. Based on the ZIP code, this location may appear first in ZIP code search results.

Acknowledgement *

Click here to acknowledge that you've read and agree to the Terms and Conditions.

Edit

Review