Username:
SIGN UP

Welcome to the Santa Clara County IPA sign up page for Access Express!

Use this form to request a user account or to ask any questions you may have about the system. A password for your new account will be sent to you once we have verified your information.

Request Type:
Username:
First name:
Last name:
Cell Phone:
Direct Phone Line:
Email:
Verify Email:
Contact Preference: Phone  Email
Manager Name
Practice Phone:   Ext/Dept: 
Office name:

Notes: