First Name

Last Name

Display Name

Your Display Name will be visible above your avatar's head to others in the VA-VMC. Display Name can be changed.

Unique Name

Your Unique Name should have the form of Last Name followed by a number. Unique Name cannot be changed.

Email Address

Must use your official email address assigned by your organization. Requests using personal email addresses will be assigned the Patient role.

Purpose of Account

Brief description of how you to use the VA-VMC.

Time Zone

Password

Password must be at least 8 characters, must contain a letter and a number, and one or more special characters.

Password Confirmation

Request Roles