Get Ssr Referring Physician Portal User Access Agreement 2019-2025

Filling out the SSR Referring Physician Portal User Access Agreement is a crucial step for individuals seeking access to the SSR Synapse Portal. This guide will provide clear instructions to ensure that you complete the agreement accurately and efficiently.

Follow the steps to complete the User Access Agreement online.

1. Press the ‘Get Form’ button to obtain the User Access Agreement and open it in the designated editor.
2. Fill in the date at the top of the form. This helps establish when the agreement is being executed.
3. Provide your full name by entering your first, middle (if applicable), and last names in the designated fields.
4. Enter your email address to ensure communication regarding your access to the Portal.
5. Indicate your professional title in the title field to clarify your role.
6. Provide your phone number and fax number to allow for contact regarding your application.
7. Fill in your office name to identify the practice associated with your application.
8. Provide your manager's name, email address, and contact number to facilitate internal communication.
9. If you are a provider, include your NPI number in the specified area to link your credentials.
10. Sign the form to indicate that you agree to adhere to the terms set forth in the User Access Agreement.
11. Once completed, print, sign, and fax the document to South Sound Radiology using the provided fax number.

Ensure your access to the Portal by completing and submitting your User Access Agreement online today.