New User Registration

Welcome to Healthix. After completing the form below, your Healthix account will be validated and activated by your local administrator or a Healthix administrator.
You will receive an email notification after completing this form.

User Name: *
Enter a User Name that you will use to log in to the Healthix Portal.
First Name: *
Last Name: *
Middle Name:
Email Address: *
Secondary Email Addres:
Direct Address:
If you have a Direct Messaging account, please enter your Direct address.
Primary Phone Number: *
Secondary Phone Number:
Title: *
License Number: *
License Number and State of Licensure required only for users with certain Titles.
State of Licensure: *
NPI: *
NPI required only for users with certain Titles.
DEA:
DEA Number should be 2 letters followed by 7 digits, with the 1st letter having one of these values: A, B, F, M, and the 2nd letter is the 1st letter of your last name. For example: FN5623740
Healthix Role: *
Select the Healthix Role that best matches your clinical role. Healthix Policies require that your Healthix Role is accurate.
Participant: *
Facility/Location:
Department:
Office Address:
City:
State:
Zip:
* indicates required field