All fields are required.
Enter your Activation Code as it appears on your enrollment letter (your code is not case sensitive). You will not need to use this code after you complete the signup process. After 5 failed attempts, this code will no longer be valid.
Please enter the last 4 digits of your Social Security number.If you did not supply a social Security Number upon registration at The University Hospital, please enter 0000.
Enter your date of birth in the format shown, using 4 digits for the year.