Create New Practitioner Account
The Practitioner Account will allow management of multiple User Accounts with a single User Name and Password.  Please enter an User Name, Password, Name, and Email Address to create a new Practitioner Account.  All fields are required and are not case-sensitive.
Account Information
User Name (Please do NOT include spaces or special characters)
First Name
Last Name
Phone: (Ex: 123-456-7890)
Fax: (Ex: 123-456-7890)
Email Address

Contact Address
Line 1:
Line 2:

Click here for parish and state contact information
Website Support
Phone  (877) 693-4435
Fax  (225) 231-6201
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