All fields are required.
Enter your activation code as it appears on your enrollment letter or After Visit Summary®. Your code is not case sensitive.
Enter your date of birth in the format shown, using 4 digits for the year.
Your medical record number must be entered using 9 digits. if your medical record number is less than 9 digits, add zeros to the beginning of your number. Example: 123456 must be entered as 000123456