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. Your Name*PhoneCompanyFaxAddressEmail* Address 2CityWould you like someone to contact you directly?YesNoStateHow do you prefer to be reached? Email Phone Fax Mail ZipPlease send us specific questions or comments in the space below:File UploadEmailThis field is for validation purposes and should be left unchanged.
