Enrollment

  • Identification
  • Confirmation

1. Enter Patient Information

Use name as it appears on the driver's license

Male Female

2. Create User ID

6-12 characters only

Numbers only. No dashes or spaces.

Please send me my activation code via:
Text message
Voice call
Note: We will send you a one-time activation code to complete your sign up, which you will enter on the next screen.

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