Account Registration
 
First Name:
 

 
Last Name:
 

 
Email Address:
 
@
 
 
 
I acknowledge and I am requesting electronic access to the Cap Management Systems provider portal.

I understand that my access and any staff member's access is a privileged right and I and my staff further understand the legal responsibilities we have to protect the privacy of our patients from unauthorized use of protected health information. We agree to protect our usernames and passwords and will not disclose them to anyone.