The fastest and easiest way to obtain an IUD/LARC for your patients

Register Now

Practice-Provider Enrollment Form

Once submitted, please watch your email for an account approval notification.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
This is going to be the account username and can not be changed.
Address*
Office Contact*
Password
Providers List*
Please provide provider list. You can add multiple providers clicking the plus icon.
Provider Name
NPI
State License #
 
Clear Signature

I understand that My-IUD LLC/Gyn CARE, INC may contact the referred patient by telephone or telemedicine for the following reasons: verification and coordination of benefits, confirmation of IUD ordered and consent, review of clinical information including safety and educational instructions.

Customer Relations Department

Contact Us