New Account Registration

Please complete the form below to request access to the Interpace Diagnostics Physician Portal. The Portal provides access to patient test reports.

If you are looking to modify a current account, please complete the change request form.

A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.

Account Type

There are two types of accounts to choose from. Please select the one that applies to you.

Institution Access Physician Access

Institution Access: Provides access to a group of delegates for an institution. Authorized Delegates are individuals authorized by the Laboratory Director or Medical Director to access all test reports or test requisitions associated with the submitting institution, such as group practice partners and staff who are permitted to access and use Protected health information (PHI) under federal law (HIPAA)

Physcian Access: Provides limited access to one physician's patient results only

Divisions

ENDO (ThyGeNEXT® and ThyraMIR®v2) GI (PancraGEN®, PanDNA®, Fluid Chemistry) Both ENDO and GI

Registration Requested by:

First Name

Last Name

Email Address

Phone Number

Title / Position

I am the primary contact for this account

Primary Contact

First Name

Last Name

Email Address

Phone Number

Title / Position

Institution Information

Physician Information

Institution Name

Location/Institution

Physician's First Name

Physician's Last Name

NPI# of Primary Physician

NPI# of Institution (if available)

Street Address

City

State

ZIP

I work at multiple locations/institutions

Location #2

Name of Location / Institution

Street Address

City

State

ZIP

Location #3

Name of Location / Institution

Street Address

City

State

ZIP

Authorizer

Institutional accounts require an authorizing director. Please select below.

Laboratory Director Medical Director

First Name

Last Name

NPI#

Phone Number

Delegate #1

First Name

Last Name

Title

NPI#

Delegate #2

First Name

Last Name

Title

NPI#

Delegate #3

First Name

Last Name

Title

NPI#

Delegate #4

First Name

Last Name

Title

NPI#

Delegate #5

First Name

Last Name

Title

NPI#

If additional delegates are needed, please contact Client Services after your account is created.

Finalize Request

Click the "Submit Request" button below to complete the request.

Interpace Physician Portal

New Account Registration