modmed Central^TM Support Center

If you’re a patient, do not fill out this form; please contact your physician directly.

Don’t Have an Account?

Request Modernizing Medicine Support Center and Knowledge Base/Community forum user accounts for employees in your practice by providing the information below.

Practice Demographics (Must be filled out within 24 hours from receipt of activation link via email - check spam filter)
Practice Name*
Phone*
Email*
Practice Street Address*
Address Line 2
City*
State*
Zip Code*
Your EMA URL*
The URL or web address you use to login to EMA (Example: practicename.ema.md)
User Demographics (Must be filled out within 24 hours from receipt of activation link via email - check spam filter)
All Employees Requesting Access*
First Name Last Name Role Email Choose Access

Please use a different email address per user

modmed CentralTM Support Center

Don’t Have an Account?

Practice Demographics (Must be filled out within 24 hours from receipt of activation link via email - check spam filter)

User Demographics (Must be filled out within 24 hours from receipt of activation link via email - check spam filter)

modmed Central^TM Support Center