Agency Registration — Pulse IQ EMS Management

Agency Information

Tell us about your EMS agency so we can tailor your account setup.

Agency Name * ⚠ Agency name is required.

Agency Type * ⚠ Please select an agency type.

Street Address * ⚠ Street address is required.

City * ⚠ City is required.

State * ⚠ State is required.

ZIP Code * ⚠ ZIP code is required.

Main Phone Number * ⚠ Phone number is required.

Website (optional) ⚠ Enter a valid URL (starting with https://).

Administrator Account

Create the primary admin account for your agency. You can add more users later.

First Name * ⚠ First name is required.

Last Name * ⚠ Last name is required.

Email Address * ⚠ A valid email address is required.

Phone Number * ⚠ Phone number is required.

Create Password * ⚠ Password must be at least 8 characters.

Confirm Password * ⚠ Passwords do not match.

Operations

Provide some basic operational details about your agency.

Number of Personnel * ⚠ Enter at least 1 personnel.

Number of Stations * ⚠ Enter at least 1 station.

Number of Ambulances * ⚠ Enter at least 1 ambulance.

I agree to PulseIQ's Terms of Service and confirm that I am authorized to register this agency. I understand that my account will be subject to a brief review before activation.

⚠ You must agree to the Terms of Service to continue.

Review & Confirm

Please review your information below before submitting your registration.