Forms

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