Registration form

Please fill out the following form to regiester for the Telepathology Consulting Service

Required fields are marked with *

Identity:

* First Name:
* Last Name:
* E-mail:

Location:

Kingmed Facility:

Verification Questions:

Please choose two verification questions and type in your answers. These questions will be used if you need to recover your password. Please only use alphanumeric characters in your answers.

* Question 1:
* Answer 1:
* Question 2:
* Answer 2:

Login Credentials:

UPMC policy requires that passwords meet these complexity requirements:

  • The password cannot be the same as the username.
  • The password cannot be the same as the e-mail address.
  • The password must contain eight characters or more.
  • The password must not be a simple word.
  • The password must contain characters from three of the following four categories:
    • capital letters
    • lowercase letters
    • numbers
    • the following symbols: ! @ $ % ^ *
  • The password CANNOT contain the following symbols: # [ ] < > " ' \ &
* Username:
* Password:
* Re-enter Password: