Create ReMed Portal Account

Please use the form below to create an account for our ReMed Portal so that you can securely submit a referral and records to ReMed, and receive reports securely from ReMed Casualty Consultants.

1. Company Information

Name*

Address*

City*

State*

Zip*

Company Phone Number*
- -

Enrollment Type for Company*

*Denotes Required Fields

2. User Information

First Name*

Last Name*

Direct Dial Number* (cell phone)
- -

Email Address* (this will be your login name)

Password*

Confirm Password*

**Please Note: Password must be between 6 and 25 characters

Special Instructions

I have read and agree with the ReMed Casualty Consultants Online User Statement

YES