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 (please fill out within 24 hours from activation)
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 (please fill out within 24 hours from activation)
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 (please fill out within 24 hours from activation)

User Demographics (please fill out within 24 hours from activation)

modmed Central^TM Support Center