Identity Self Service

User Verification

*Enter the code above

Basic Information

*First Name

Middle Name

*Last Name

*E-mail

*Confirm E-mail

Display Name

An email address is required to apply online at Vermont Health Connect. If you do not have an
email address, you can create one for free online. If you would rather apply over the phone or
need more help, please call our customer support center: 1 (855) 899 9600.

Enter Username and Password

*Username

Username cannot be an email address

*Password

*Confirm Password

Please choose a password that meets the following requirements:

Password MUST:

Be at least 8 characters long
Start with a letter
Use at least 2 letters
Use at least 1 upper case letter
Use at least 1 lower case letter
Use at least 1 number
Use at least 1 special character

Password CANNOT:

Match or contain username
Match or contain first or last name
Use or contain a space
Use common dictionary words

Select your challenge questions and answers

The challenge questions and answers are used if you forget your password and need to reset it.

*Question 1

*Answer 1

*Question 2

*Answer 2

*Question 3

*Answer 3

User Registration

User Verification

Basic Information

Enter Username and Password

Select your challenge questions and answers