Demo & exclusive access
Complete the form below to request your dedicated OptiSina instance and begin the onboarding process.
Please fill up the information to request your OptiSina instance build.
01Practice Information
Practice Address
02Practice EMR / EHR System
03Locations & Facilities Served
⚠️ Important Notice Regarding EMR Connectivity: Please be advised that EMR vendors may assess a third-party integration or connectivity fee per facility (for example, PointClickCare charges approximately $65 per facility). These fees are separate from OptiSina’s service charges and are the sole responsibility of the client. Our team will provide full transparency on applicable fees during the onboarding process.

Please list up to 3 facilities below.

Facility 1

Facility 1 Type

Facility 2

Facility 2 Type

Facility 3

Facility 3 Type
04Users & Roles

Please list up to 4 users who will need access to OptiSina.

User 1

User 1 Role(s)

User 2

User 2 Role(s)

User 3

User 3 Role(s)

User 4

User 4 Role(s)

Evaluation & Management (E&M)

E&M CPT Codes

Consultations

Consultation CPT Codes
Procedure CPT Codes
06Priorities & Timeline

Rank each feature — 1 = Highest Priority, 5 = Lowest Priority.

Preferred Onboarding Start Date
07Agreement & Signature
Agreements