Thank you for choosing Provider Practice Essentials for your continuing education! We know what its like sometimes to get the information you need to the people who handle your continuing education funding. This form will allow you to provide your employer with everything you need to register, including:
- Detailed Course description including all of our content detailed by objective
- Schedule of events – by day – for verification of the program
- A one-time signup sheet that will allow you to submit all of the materials to your employer/scheduler.
Please complete the form below in its entirety. We require an individual email address for access to our website and to obtain a post-course certificate. If you are completing this form for someone else, please ensure that all of the information requested is accurate. We will not be held responsible for submissions that contain incorrect data. If you are paying by Check or Money Order, we will process formal registration for our program once payment has cleared. Mail-in registrations do not qualify for additional discounts or promotions. We encourage you to take advantage of our contracted hotel rates at the course location. Once you have completed the registration form, you will receive an email confirmation. Please print this form and submit a check for the total amount detailed at the bottom of the page.