Welcome

Welcome to TrueEval Onboarding. This quick form (4–6 minutes) collects the details we need to activate your clinic inside TrueEval’s systems. Please have your EIN, clinic info, banking info, and logo file ready.

Clinic Legal & Business Information

Legal Business Name *

Business Registration Number (EIN) *

Clinic Address *

City *

State *

Country *

Postal Code *

Business Phone Number *

Clinic Website *

Primary Contact

Time Zone *

Primary Contact Full Name *

Primary Contact Email *

Primary Contact Phone *

Confirmation

Clinic Logo Upload *

Upload Logo – Square (500×500) & Rectangle (1200×300), PNG/JPG

Brand Colors (Hex Codes)

Public Clinic Name / Tagline

Compliance & Provider Info

Lead Provider / Medical Director Full Name *

License Number *

License States *

NPI Number

Upload License Documents *

Messaging & Telehealth Setup

Support Email Address *

Support Phone Number *

Preferred Patient Messaging Method *

Visit Types Offered *

Async

Consults

Live Video Visits

Banking & Payout Setup

Bank Name *

Routing Number *

Account Number *

Account Type *

Authorized Signer Name *

Domain & Marketing Access (Optional)

Domain Registrar

Do you have access to your domain host?

Yes

Current Email Provider

Marketing Contact Name

Marketing Contact Email

Marketing Contact Phone

Confirmation

All Set!

Thank you for completing your onboarding form. Our team will activate your clinic inside TrueEval and confirm once your subaccount and EMR are ready.

If you have any questions, please email us at [email protected]