TRAINING
RESOURCES
ADMIN
MARKETING
OPERATIONS

USER REQUEST FORMS.

FILL OUT THE FORM BELOW FOR EVERY NEW HIRE.

THIS ALLOWS THE ADMIN DEPARTMENT TO SET UP THEIR ACCOUNTS AND ENSURE THEY HAVE THE ACCESS THEY NEED.

Entity Name *

Entity DBA *

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Gender *

New Employee Gender

Male
Female
Transgender
Unknown
No elements found. Consider changing the search query.
List is empty.

Position Category *

QMHP - CS
Admin Coordinator / Assistant
Clinician
Liaison
Franchisee Owner
No elements found. Consider changing the search query.
List is empty.

Please Specify Position

Position Effective Date *

If you have any questions about this form or the process to add a user, please contact the Administrative Department at the Corporate office.

Office: (888)988-6329

Email: [email protected]

Accounts Requested

EHR User Name

EHR User Status

Admin Only

Pending
Complete
Training Incomplete
No elements found. Consider changing the search query.
List is empty.

MedTrainer User Name

MedTrainer User Status

Admin Only

Pending
Complete
No elements found. Consider changing the search query.
List is empty.

CMBHS Username

CMBHS User Status

Admin Only

Pending
Complete
Training Incomplete
No elements found. Consider changing the search query.
List is empty.

TMHP Username

TMHP User Status

Admin Only

Pending
Complete
Training Incomplete
No elements found. Consider changing the search query.
List is empty.

TCHP Portal Username

TCHP Portal Status

Once submitted and processed, the user will receive an invitation email with their login credentials. Your administrator will then need to add profile details to the user’s account.

Please allow up to 3 business days for accounts to be created. Please note, access to EHR, TMHP, and CMBHS systems will only be granted after all required training has been successfully completed.

Your Full Name *

Your Email *

By checking this box, I confirm that I am requesting user accounts only for employees who have completed all required onboarding steps, including but not limited to: a signed offer letter, signed job description, signed employee handbook, and a completed background check.

By checking this box, I understand that once user accounts are created, the Franchisor will begin billing the Franchisee for each user. Billing is per user and is not prorated, regardless of actual usage.

Office:

15603 Kuykendahl Rd. Suite 300

Houston, TX 77090

Call

888-988-6329

Email: [email protected]

Site:

www.texascarecenter.com

USER REQUEST FORMS.

FILL OUT THE FORM BELOW FOR EVERY NEW HIRE.

THIS ALLOWS THE ADMIN DEPARTMENT TO SET UP THEIR ACCOUNTS AND ENSURE THEY HAVE THE ACCESS THEY NEED.

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