Provider Registration

Thank you for submitting your Provider Registration. Welcome! Your submission will be reviewed by WPH administrators.

Create Your Account

Create a login so you can manage your listing after approval.

Your Name *

Your Phone

Email Address (Username) * This will be your username for logging in.

Password * Minimum 8 characters.

Confirm Password *

Practice Information

Physician Name *

Group Name Enter the practice or group name if different from the physician name above.

Medical Group *

Every provider listing belongs to a medical group. Solo practices count as their own group — choose “add it” and enter your practice name.

Minority-Owned Provider Check if this is a minority-owned practice (Georgia requirement).

Phone Number *

Street Address *

City *

State * Select the state where you primarily practice.

ZIP Code *

Telehealth Services

Telehealth services are available

Upgrade to a Premium listing $950.00 per year

Premium listings include your logo, practice description, website link, and a Workers’ Compensation liaison contact, and appear above standard listings in search results. By checking this box you agree to an annual subscription of $950.00, which renews automatically each year until cancelled. You may cancel at any time from your provider dashboard. After submitting this form you will be taken to our secure payment processor.

Leave this unchecked for a free Basic listing. For even more information, click here.