Please Identify Yourself

Step 1

All fields are required.

Enter your Activation Code as it appears on your after visit summary or email (your code is not case sensitive). You will not need to use this code after you complete the signup process. If you do not have an activation code, please request one by clicking on the Request Activation Code Online button.

Please enter Last 4 SSN or complete Canada Health Card Number.

xxxx or xxxxxxxxxx Show SSN/Canada HCN
Date of Birth

Enter your date of birth in the format shown, using 4 digits for the year.

mm
/
dd
/
yyyy