User Registration

PA Registration Portlet

ProviderAccess Registration

Complete the following information. * Required

User ID

Must be 8 to 20 characters
Must contain at least 1 letter
Cannot contain special characters

Password

Must be at least 8 characters
Must be GOOD or better on strength meter
Cannot be your User ID
Consider a "passphrase" instead of a password (Example: theskyisbluetoday)

Password Strength:

Confirm Password

First Name

Last Name

Phone

Ext

Email

Confirm Email

Node:bclrprvappp1001.corp.bcbsal.org:8080