PROVIDER REGISTRATION
Please complete ALL fields in the form below to register for online access. For security reasons, please print, sign, scan and email the activation request form to info@libertyhealthblue.com.

Once we receive and capture your details, we will send you a password. Your password allows you to log in at any time to check your patients' membership and benefit details, and the status of claims submitted.

For an explanation of each form element, move your cursor over each field name

First Name
Surname
E-mail Address
Confirm E-mail address
Practice Number
Country
Password
Confirm Password