Provider Account Request

Please fill in the fields below to create your account.

Account Information
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Required
Password must be Minimum length of 12 characters, Contain Upper and Lower Case Letters, Contain at least 1 Number, Contain at least 1 Letter, Contain at least 1 Special Character
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User Information
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Provider Information
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Press the enter key between ID's
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For account creation help, please contact support at support.information@healthsmart.com or call 1-800-638-0968.
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