Provider registration form – AHSA Doctors

Use the Provider registration form to register your provider numbers with AHSA for Access Gap Cover (AGC).

Once received, AHSA will confirm your registration via email.

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Please note that this form should be used to register any new provider numbers. If your provider numbers are already registered with Access Gap Cover, you do not need to re-register.

Note: Please make sure that you complete all sections of the form and refer to the checklist at the end.

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