To submit a credentialing request, please either send an email to Credentialing@betahg.com or fill out the below form. Please make sure to include a signed release with your request as well. "*" indicates required fields Your Name*PhoneCompanyFaxAddressEmail* Address 2CityWould you like someone to contact you directly? Yes No StateHow do you prefer to be reached? Email Phone Fax Mail ZipPlease send us specific questions or comments in the space below:File UploadMax. file size: 50 MB.EmailThis field is for validation purposes and should be left unchanged.
