Site Registration

Plan Members Please enter your Certificate Number and name exactly as shown on the Identification Card you received from your Scholars Medical Program or your plan administrator. If you don't have a Certificate Number please contact your benefit administrator or call +1.866.750.6125.
	Certificate Number:
	First Name:
	Last Name:
	Date of Birth:	(DD-MMM-YYYY)
Please complete the information below so we can recognize you online at Scholars Medical Program
	Email Address:
	Confirm Email Address:
	Your email address will act as your username.
	Password:
	Confirm Passwords:
	Your password must be between 10 and 16 characters. Password should have letters and numbers and at least one capital letter and one special character.

		I have read and accept the conditions of the Site Access Agreement