If you are interested in signing up for HEALTHeNET application usage, please click on the "Request Form" link, and complete and submit the form. A HEALTHeNET representative will contact you within 5 business days of your request to provide further instructions and schedule training.
Request Form

These forms(PDF) are required to be completed for HEALTHeNET sign up

HEALTHeNET Software License Agreement
HEALTHeNET Practice Confidentiality Agreement
HEALTHeNET HIPAA Business Agreement
HEALTHeNET User Administration Form
HEALTHeNET Group Administration Form
Please send completed forms to HEALTHeNET, c/o PCI Help Desk, 703 Washington Street, Buffalo, NY 14203


Download the PDF version of the tutorial

Email Contact
Password and login support is not available through email. Your authorized contact must call the PCI Help Desk at 1-877-895-4724 for login support.