If you are interested in signing up for HEALTHeNET application usage, please click on the “Request Form” link, and complete and submit the form. A HEALTHeNET representative will contact you within 5 business days of your request to provide further instructions and schedule training.
These forms(PDF) are required to be completed for HEALTHeNET sign up
Please send completed forms to email@example.com or HEALTHeNET, c/o PCI Help Desk, 703 Washington Street, Buffalo, NY 14203
Password and login support is not available through email. Your authorized contact must call the PCI Help Desk at 1-877-895-4724
for login support.