EZCLAIM ACCOUNT CHANGE FORM

Account Change Form

With this form, you can change the Contact Information, Logins, Company File, and request a variety of Miscellaneous changes.

  • Contact Information

    Please fill out the information below and we will make the changes requested.

    Attention: To update your credit card on file please click on this link.

  • MM slash DD slash YYYY
  • Sharing logins is not recommended due to HIPAA regulations

  • Add/Remove Logins or Add/Remove EZClaim Company Files

    Please indicate if you would like to add or remove a login in this section (example: Please add 2 users with access to Billing and Scheduling OR please remove EZClaim1 from our account). If not adding or removing logins, please enter N/A.


  • General Account Change Requests

    Please indicate if you would like to change general things on your account such as adding or removing Password Authorities (please list new Password Authority names AND e-mail addresses), changing address of the account, or any other general changes not applicable to other sections.) If not making any general changes, please enter N/A.

    Attention: To update your credit card on file please click on this link.

  • What's Next?

    Submit this form. Forms are processed within one or two business days. If you have any questions, please call 877-650-0904.