InterMed

Account Number

Your account number is listed on your statement.

If you are enrolling an account with a SURGICAL CENTER STATEMENT, please use your Patient Number and add the letter S as the last character if your Patient Number does not already end with an S.

Date of Birth

Enter the date of birth associated with the account holder

Phone Number

I would prefer to receive paperless invoices and statements:

First Name

Last Name

Mobile Number

Enter the mobile phone number to receive text alerts

Email

Re-enter Email

Choose Password

Password must contain at least six alphanumeric characters plus at least one punctuation character

Re-Enter Password

Password Hint

Security Question

Security Answer

Yes, I accept the

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