• 1. License Info
  • 2. Account Info
  • 3. Finance Info
  • 4. Finish
Get started by filling out the online account application :

 Upload professional license   Fill out Practice Info   Provide financial info/consent signatures   Review and submit

Or, you can click here to print and complete the application offline and mail the completed application and a copy of your license showing its expiration date to:

Doctor's Data, Inc.
3755 Illinois Avenue
St. Charles, IL 60174-2420

Doctor’s Data Account Application

Thank you for your interest in opening an account with Doctor’s Data. Please answer the following questions to streamline your application process. Please note: For security purposes, Doctor’s Data does not save your information. If you need to exit the application process before submission, your information will not be saved and you will need to start the application again. Please do not hesitate to Contact us.