Designee Registration

Eligibility Information

Designees and their supervisors must be located in Illinois in order to register for an account.

You must be currently employed as one of the following to register as a designee:

Select your role:

Do you have a License Number associated with your role?
Yes No

Do you have a NPI Number?
Yes No

Please provide your personal information.

First Name *

Last Name *

Email *

It is recommended to use an email address that is not associated with your practice or current employer, as this will be used for account recovery.

Confirm Email *