Request an Activation Code via Postal Mail

If you are at least 18 years old you can fill out the secure form below to request that an Activation Code be mailed to the address we have on file for you. (If you have recently changed your mailing address, please contact us at 1-888-979-1414.)

This information is used to verify and match your records. All information is kept confidential. If you would like, you can also create your account online or request access to another patient's account.

All fields are required unless marked "(optional)"

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