Register

Welcome to the LabAnnex Registration Form.
*Fields marked in bold are required.
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LOGIN INFORMATION
* UserName:
Desired User ID must be 5 characters or more in length.
* Password:
Password specified must be at least 6 characters in length.
* Retype Password:
* PIN Code:
 
 
In the future, if you forget your Customer ID or Password, you must provide your PIN number in order to receive your login information. We recommend using the last 4 digits of your SSN.
* Email:
* Retype Email:
Please be sure to enter a valid email address. We will use this address as a main source of communication, including sending you the complete login confirmation.
ACCOUNT INFORMATION
* Lab Name:
* Address 1:
Address 2:
The account information specified in this section will be used for printing your custom Invoices and Statements. Please be sure to enter this information exactly how you would like it to appear on these documents to your customers. This information may be modified later in the Account Settings section.
* City:
* Country:
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* State:
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* Zip Code:
Tooth Chart Type:
Select your preferred Tooth Chart System.
CONTACT INFORMATION
* First Name:
* Last Name:
* Office Phone:
Fax:
Cell Phone:
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I have read and fully agree with the terms and conditions use of LabAnnex service.