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Registration

New Provider Registration

As an authorized provider of health services, you will be able to view and access valuable account and medical information online.

Enter provider information in the form below and then click the Register button.

* Indicates required information

Physician & Billing Information
Contact
/ /
(Area Code & Number)
User ID & Password
User ID may contain any of the following (space . @ _ -). Example: John Smith j_smith@my-address.com
Password must be a minimum of 8 characters with at least 1 number and 1 upper case letter.
Password Recovery Security Questions

You will need to select and answer a minimum of 4 security questions. The questions will be randomly displayed in the event you forget your password. After you enter the answers correctly you will be allowed to reset your password.

Select 3 unique questions and enter one of your own questions below.

  Security Question Answer
* 1:
* 2:
* 3:
* 4: