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New Clinic & Hospital Application

Start ordering with Optimus Labs Solutions in as little as 48 hours. Only the fields marked with ★ are required.

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Provider Application

★ Fields marked with a star are required. All other fields help us set up your account faster.

🧑 Provider Information
Please enter your first name.
Please enter your last name.
Please enter a valid 10-digit NPI number.
Please enter a valid phone number.
Please enter a valid email address.
🏢 Facility Information
🧪 Testing Details
💳 Billing Information
📜 Report Delivery Method
👥 Additional Contacts
Facility Administrator
Business Office Manager
📋 Additional Notes
✎ Provider Signature
Sign here
Please provide your signature.

✓ Application Received!

Thank you for applying. Our Provider Relations team will contact you within 1 business day to complete your setup.

What Happens Next

1
Application Review
Our team reviews your application within 1 business day
2
Account Setup
You receive portal credentials and supply order within 48 hours
3
Onboarding Call
A dedicated rep schedules a 30-minute training session
4
Start Ordering
Your account is active — begin submitting specimens immediately
Questions Before Applying?

Call our Provider Relations team at 305-320-4332 or email info@optimuslabsolutions.com

Only 5 Required Fields
  • ★ First & Last Name
  • ★ NPI Number
  • ★ Phone Number
  • ★ Email Address
  • ★ Provider Signature