CuraNet Member Resources


Provider Nomination

If a doctor or practitioner is currently non-participating with CuraNet, you can nominate them to join CuraNet. Please complete the following information. Completion of this form does not guarantee acceptance of the provider as a participating provider.

Your Information
Your name
Address
City   State
Zip code
Phone
Email
Cardholder
Employer

Doctor/Practitioner Information
Title
Last name
First name   MI
Specialty
Address
City   State
Zip code
Phone
Email

Completion of this form does not guarantee participation of provider.

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