CooperCare Link Application Form

If your practice is already using CooperCare Link, click here to log in.

For new applicants, please complete the below information. You will be asked to designate a site administrator, who shall act as the liaison between Cooper and your office.

Please note, once your CooperCare Link account is activated, you will no longer receive fax communications from Cooper University Health Care. All communications will come through CooperCare Link. You will receive email alerts when Cooper has sent a communication about one of your patients.

Practice Information
Practice Name*
Address*
Address 2
City*
State*
Zip Code*
Phone*
Fax
Email*
Group NPI*
Add Doctors
Add all physicians in your group.
Name
NPI
License #
Add Another DoctorRemove
Site Administrator
Please note that the email provided for the site administrator will be the account that receives alerts when Cooper University Health Care uploads information for any patient of the group.
First Name*
Last Name*
Email*
Site Admin Phone*
Please acknowledge by checking this box that you have read and understand that, following your submission:
- You will receive an email confirming receipt of your CooperCare Link application.
- The email you provided for the site administrator above will be where all communication alerts will be sent by Cooper.
- You will be able to add users and additional emails by contacting privacyofficer@cooperhealth.edu.
- You must complete and fax the Site Indemnity Agreement, which will be available after clicking the continue application button below.
*
- I AGREE
Comments
This field is for validation purposes and should be left unchanged.

Practice Information

Add Doctors

Site Administrator