Health Provider Registration

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Create new account(active tab)
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Request new password

Health Provider Registration

Member Area

System Information

Username *

Spaces are allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores.

E-mail address *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Password *

Confirm password *

Provide a password for the new account in both fields.

First Name *

Last Name *

Health Provider

Suspend Account

Provider Registration

Registration Number

Please provide if applicable. (Not the same as the Dental Provider Number).

Office ID

Use this field to identify this office. Example: Store 1, or Toronto office. You can use letters and numbers.

Clinic Name *

Phone Number *

Phone Extension

Mailing Address *

City *

Province *

Postal Code *

Direct Deposit

Copy the FIRST DIRECT DEPOSIT RECORD into ALL empty records - or just to this record.

Update This Record Update Empty Records

Institution Number *

This is a 3 digit number

Transit Number *

This is a 5 digit number

Account Type

Account Number *

The account number can be a 7 to 12 digit number

Verify Direct Deposit

IMPORTANT! I hereby authorize The PBAS Group, and its Administrators, to deposit payment to my account as indicated above. I understand that this information will be kept confidential and secure, and that it will only be used for the purpose identified herein. This authorization may be terminated at any time upon written notice by me.

Account Number

Direct Deposit Email *

This email will be used for sending payment notifications.

Weight for row 1

Verify Provider Registration *

Terms and Conditions

The PBAS Group, and their Administrators has taken the necessary measures to protect the confidentiality of the personal information provided and to ensure that your electronic transactions are secure.

Provider Authorization Confirmation
I, hereby confirm that the information contained in this form is true and complete to the best of my knowledge or any of my colleague’s knowledge; and, that the student for whom I am making a claim is aware that a claim is being submitted to The PBAS Group their behalf. The student will be notified by email when payment has been released.

As a provider, The PBAS Group has the right to verify the accuracy of the information you have provided to support the claim. The PBAS Group may request the original receipts and any supporting documents within 12 months of the date your submitted the claim online. I understand and authorize that in the evidence of fraudulance claim, The PBAS Group has the right to release the claim to all relevant regulatory, investigative or government body, student organization or any other party as provided by the law of investigating such fraud.

Security question

To reset your password in case you have forgotten it, a security question will be asked to verify your identity.

Question *

Choose the question that you would like asked.

Answer *

Type the answer to the question you have chosen.

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Health Provider Registration

Primary tabs

Member Area