About OWL Patients 

Physicians/Providers 

Enrollment 

FAQs - Patients

 FAQs - Clinical

Contact Us 

Practice

Please provide some general information about your practice. The primary contact / administrator will be notified regarding any system updates or issues. This person will also be responsible for auditing this tool for inappropriate access by practice personnel.

 
 
 

Primary Address*

 
 
 
 

Do you have an EMR in place at your practice?*


 

Physicians

Please enter all active physicians (full names) associated with your practice and include their Mountain States Health Alliance medical staff status when applicable. Email addresses will be used to send information needed to complete self-registration.

 

Is Physician 1 credentialed?*


 
 

Is Physician 2 credentialed


Is Physician 3 credentialed


Is Physician 4 credentialed?


Is Physician 5 credentialed?


Is Physician 6 credentialed?


Staff

Please enter all practice personnel, including their job title, who require user accounts to access OWL. Email addresses will be used to send information needed to complete self-registration.