Reliance Enrollment Form
For enrolling newly participating organizations
Reliance Provider Change Form
For those organizations currently with Reliance needing to update, add, or remove listed providers
Reliance Add/Remove User Form.
For those organizations currently with Reliance needing to add or remove users
If you are experiencing any issues with our forms please contact HelpDesk@RelianceHIE.org or call (855) 290-5443 Option 1