PMN Registration – Simons & Associates Law, P.A.

Thank you for joining the Practice Management Network. You must fill out the Member Registration Form below for your membership to be approved. Please allow 1-3 days for your registration form to be processed. You will be notified by email after your registration form has been reviewed.

Practice Management Network Membership Form

First Name:

Last Name:

Practice/Business Name:

Practice/Business Website:

Practice Street Adddress:

City:

State:

Zip:

Type of Practice:

Biographical Info:

How many professional staff do you have?

How many total employees?

E-mail:

Username:

Password:

Password has to be at least 8 characters long
and must not contain spaces

I agree to the Terms of Service

By joining the Practice Management Network membership, you agree to the pay $35 per month for a minimum of 12 months. After 12 months, you will continue to receive membership benefits at $35/month until you unsubscribe on our website. You understand that your membership is subject to administrative approval and your compliance with these terms of service. If you violate the terms of service, your membership may be terminated at any time. PMN membership is restricted to out-patient physical and occupational therapy practices or independent consultants in states where we have an affiliated attorney. Membership is not open to therapists who work for or consult with third party or governmental payors, auditors, enforcement or compliance agencies, or any other individual or entity that our information and content is not intended for. We reserve the right to be the sole party who determines for whom and what purpose our content is intended for and may terminate any individual's or entity's membership for any or no reason upon giving notice.Your membership status does not necessarily mean we have an attorney-client relationship. You should realize that there is no guarantee of confidentiality of anything you say or share in an on-line webinar or live meeting that we sponsor. Your expectation of privacy for any information you share with us should be limited to non-public information you communicate to us through secure methods of communication when seeking legal advice. E-mail, unless encrypted, is not secure and we are not responsible for any confidentiality, privacy or security breach that results from unauthorized access to e-mail regardless of how the e-mailed information was accessed or who initiated or sent the e-mail correspondence. E-mail and phone consultation included in the PMN package of services is limited to short Q & A. It does not include scheduled lengthy phone conferences or long e-mail correspondence related to other legal work we are doing for you. If we have to do any research or other work to answer your questions, you will be billed at our member discount rate (consult the affiliated attorney for your state for the discount rates that apply to you). We can provide consultation and education on general practice management and federal law compliance issues but we can only provide legal advice on state law matters if we have an affiliated attorney licensed to practice law in your state. Generally speaking, you will need to be a member of My Legal Counsel in your state (if available) to obtain legal advice on state law issues or legal services that require an attorney licensed in your state. If you request legal services outside the scope of what the PMN membership provides, we may provide additional services at the member discount rate currently in effect subject to confirmation that we do not have any conflicts of interest and we are able and agree to perform the work you request. If we are unable to meet your needs or have a conflict of interest, we will make every effort to refer you to another professional or service that can meet your needs. We do not share our member list or your tax ID or NPI numbers with third parties. We will not share other personal or proprietary business information with third parties without your consent if we know in advance that such information is considered confidential and proprietary. You may share access to the Members Only content on our website with your staff but you may not share your password, Members Only website content, or any other information you gain access to by being a member that is not public knowledge with any third party outside of your business organization. All information posted on our website is our intellectual property and you are not permitted to reproduce or disclose it to third parties outside your organization without our express permission. You agree that you will not share your password to anyone else outside of your company. You further agree that you will change your password and notify us immediately if you know or suspect that your password has been compromised or an individual that you allowed to use your password is no longer with your organization.