Department of Managed Health Care Great Seal of the State of California

Creating a New Account


Please Note - This is not a secure Web site and this application is subject to disclosure under the California Public Records Act.

You will need the following information when creating a new account to log in:

If an individual
Contact Information
First Name
Last Name
Daytime Telephone Number
Mailing Address
E-mail Address


If an organization
Contact Information
First Name
Last Name
Daytime Telephone Number
Mailing Address
E-mail Address

Organization Information
Organization's Name
Physical Address
Is this a nonprofit Organization
Under what Statute is the Organization Incorporated
Organization's Size
Organization's Structure
Description of the organization's general purposes

Governing Body Information
Titles, Names and addresses of the organization's governing body