Life Force Management - Ambulance Billing Specialists

Client Registration

Please fill in all the information below to setup your new account. If you have any problems, please feel free contact our IT :


Registration Form

All sections are required.

Contact First Name:
Contact Last Name:
Business Phone Number:
eMail Address:
Department Nickname:
(no spaces, 10 char max)
Username: (no spaces, 20 char max)
Password: (no spaces, 20 char max)
Re-enter Password: (no spaces, 20 char max)