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RepCertify
For representatives

Request rep access. Get credentialed once.

You do not need a practice or a location count — this is for you, not your employer. Tell us which facilities you visit and we will start your registration.

One profile, every facility

Upload your documents once and carry the same compliance status between sites.

You choose the channel

Email, phone, and text permissions are recorded separately.

No patient data

This form is only for business inquiries and never asks for PHI.

Inquiry privacy notice

RepCertify uses these details to review and respond to your business inquiry, evaluate service fit, and maintain a record of the conversation. Access is limited to authorized RepCertify operators. We do not ask for patient information, credentials, payment details, SSNs, or TINs here.

Contact permission is recorded per channel and can be withdrawn during follow-up. Inquiry records are retained only under RepCertify's approved business and legal retention rules — see the Privacy Policy (opens in a new tab).

Tell us about you

Fields marked with an asterisk are required.

What brings you here?

Choose the closest match. The rest of the form follows your answer.

Business contact

Use the details you want associated with this inquiry.

Required only when you choose phone or text contact.

Complete this only if you selected Other.

Who you represent

Optional. Leave it blank if you are independent — it will not hold up your request.

Optional. An independent representative can leave this blank.

Where can we help?

Select all that apply. This tells us which requirements to prepare for you.

Your message

Share enough context for a useful first response.

Do not include patient information, medical records, credential documents, SSNs, TINs, or payment details.

How may we contact you?

Choose a preference, then explicitly approve that channel. Approvals for the other channels remain optional.

These permissions, and everything else on this form, are handled under the Privacy Policy (opens in a new tab) and the Terms of Service (opens in a new tab). You can withdraw any permission at any time by replying to us or by texting STOP.

By submitting, you acknowledge the inquiry privacy notice on this page and the Privacy Policy (opens in a new tab). Only the contact channels you explicitly approve will be used for this inquiry.