Alberta Health Services CCA

Step 1. Create Billing Contact

Step 2. Activate Account

Step 3. Account Activated

Contact Information Note: Red text indicates required fields.

Billing First Name:

Billing Last Name:

City:

Phone 1:

Phone 2:

Email:

Alternate Email:

Client #:

Account Information

Username:
		* We suggest your email address (Min Characters: 5)

Password:

Re-Type Password:

Password Strength

Note: For the best Password Strength rating include:

Extra Information

Birthdate:

Text Field 1:

Security Check

Captcha Verification