Reliance Enrollment Form – Long Form.
For large, multi-provider or multi-location organizations
Reliance Enrollment Form – Short Form.
For enrolling organizations with 3 or fewer locations and/or 6 or fewer providers
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