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Please enter your personal information using your legal name and the email address on file with your employer.

Username:

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Password:

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Your username is the email address on file with your employer.
If you forgot your password, click the 'forgot password' link and enter the email address used to create your account.

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Please enter your personal information using your legal name and the email address on file with your employer.

First Name:

First Name is required field

Last Name:

Last Name is required field

Phone:

Phone must be a valid phone number

Date of Birth:

Please enter a valid date

Zip:

Zip is required field

Your email address (Username): Enter the email address you would like to have as your username. This is the email address where you will receive your registration confirmation, secure message notifications, and other important updates from ActiveCare so please make sure this is a valid, private email address. ActiveCare will never share your e-mail address with anyone.

Required Field

The email address you entered is invalid. Please enter a valid email address.

Email Address Confirmation:

The email address confirmation does not match your email

Password:

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Password is required

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Password Confirmation:

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Password Confirmation is required

Passwords don't match

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