Make sure that you enter DOB in the format mentioned in the form. For example, if your DOB is June 20, 1990, enter ‘06/20/1990’ (for mm/dd/yyyy format)
If you get date of birth mismatch error, there is a possibility that an incorrect Date of Birth is entered by your practice. Contact your practice for correcting it.
Choose your preferred username (Login ID) and password. Username and Password are case sensitive. Hence make sure that you enter them in proper case.
Enter the text that you see in the image and click on ‘Submit’.