Thank you for your interest in Ivanity’s MD Coverage Program.

This enrollment request allows Ivanity to review your professional credentials, practice information, requested services, and clinical needs prior to approval.

Submission of this form does not constitute approval, physician delegation, medical supervision, prescriptive authority, or authorization to begin practicing under an Ivanity-affiliated physician. Coverage becomes active only after approval and completion of all required agreements, credentialing, onboarding, applicable physician orders/protocols, and fees.