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NEW PRACTICE INFORMATION FORM

Welcome to the CND Life Sciences community! The information you share in this form will help ensure smooth communication–from results reporting to faster issue resolution and more. Here are a few tips to keep in mind:

  • Please complete one form for each practice location
  • Remember to update your contact information regularly

New Practice Information Form

Essential Practice Information

Practice Address(Required)
Lookup(Required)

Primary Point of Contact

Name(Required)
Note: This can be a general email inbox if available.
Preferred communication channel(Required)

Ordering Clinicians’ Contact Information

Name(Required)
Medicare Credentialed(Required)
Preferred communication channel(Required)

Name
Medicare Credentialed
Preferred communication channel

Name
Medicare Credentialed
Preferred communication channel

Who should we contact regarding patient benefits and prior authorizations?

Name
Preferred communication channel

Who should we contact regarding any case discrepancies?

Name
Preferred communication channel

Who should receive the pathology reports?

Name
Preferred communication channel

Anything else we should know?

Thank you for trusting us as a partner to your practice and the patients you serve.

If you have questions, please contact your Clinical Account Manager or email support@cndlifesciences.com

Your information will not be shared with third parties.

For Clinicians: Request a Skin Biopsy Test Kit

Our suite of neurodiagnostic tests provides clinicians with objective pathological insights on diseases that are often difficult to diagnose. Using our Skin Biopsy Test Kit, collect three small skin biopsies from your patient, send them to our CLIA-certified and CAP-accredited lab, and CND will provide important pathological insights to support a diagnosis.

Order a Kit