To protect the security of personal information, your Internet browser will need to be upgraded to access this website. Please ensure you use the latest version of:

Internet Explorer

Microsoft Edge

Mozilla Firefox

Google Chrome

Safari

The wait is over!

Our member site and app have undertaken a massive makeover to serve you better. To access the app, please uninstall and reinstall any versions older than 5.0.1 on Apple and 5.0.1 on Android.

Respiratory benefit provider

Request for changes to secure website access

Note:Asterisks [*] indicate required information.

Provider information

Please enter your existing information

Please enter the provider name
Please enter your Login ID
Please enter a valid address.
Please enter a valid city.
Please enter a valid Postal Code.
Please enter a valid email address.
Please enter a valid phone number.
Please enter a valid fax number.

Requested changes

* Please indicate the changes you’re requesting below and provide any mandatory information required for the changes you’ve selected in the sections that follow










Practitioner 2

Please enter the practitioners name
Please enter the college or association name

Practitioner 3

Please enter the practitioners name
Please enter the college or association name

Practitioner 4

Please enter the practitioners name
Please enter the college or association name

Practitioner 5

Please enter the practitioners name
Please enter the college or association name

Practitioner 6

Please enter the practitioners name
Please enter the college or association name

Practitioner 7

Please enter the practitioners name
Please enter the college or association name

Practitioner 8

Please enter the practitioners name
Please enter the college or association name

Practitioner 9

Please enter the practitioners name
Please enter the college or association name

Practitioner 10

Please enter the practitioners name
Please enter the college or association name
Add Practitioner