How to become a Patriot Healthcare Producer
You can call Dina Parker at 603.296.0312 or email her at dparker@patriothealtcare.com to request a New Producer Packet with all of the necessary forms that you need to complete included in it.
Or, you can download the 3 forms below, complete them, and fax them back to Dina Parker at 603.296.0315.
- Producer Application (Click here)
- Producer Agreement (Click here)
- IRS W-9 (Click here)
After we have received your completed forms we will sign the Producer Agreement form and send a copy back to you along with a New Producer Packet.
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