Single User My Smarter Care Registration Single User Form Name(Required) First Middle Last Address(Required) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Text Message Capable(Required)Two users cannot share the same text message capable phone number. Enter a unique phone number for each user.Email(Required) Enter Email Confirm Email Preferred Language(Required)EnglishSpanishAge(Required)Please enter a number from 15 to 99.Biological Sex(Required)FemaleMaleIn TransitionPregnancy(Required)Not ApplicableTrying to Concieve NowI am in my First TrimesterI am in My Second TrimesterI am in my Third TrimesterI am Due Any DayDo you smoke?(Required)YesNoWould you like to recieve Behavioral Health Support?(Required)YesNoAre You Diabetic(Required)YesNoAre you undergoing Cardiac Care?(Required)YesNoDo you have High Blood Pressure(Required)YesNoAre you over weight?(Required)YesNoAre you struggling with Substance Abuse?(Required)YesNoCurrent Health Insurance Provider(Required)AetnaBlue Cross Blue ShieldCignaHumanaPHCSUnited HealthcareUMPCNoneConsent(Required) I Agree to the Terms, Conditions, and End License User AgreementI accept the Terms, Conditions, and End User License Agreement as posted on this website. I understand My Smarter Care will be sending me emails, test (SMS) messages, and HIPAA compliant chat messages. I understand for My Smarter Care to empower me, to take control of my health, accepting emails and messaging is essential.