Please enter your First Name, Last Name, Gender, Date of Birth and Regence Member ID#
Regence Member ID# see an example
Gender Gender Male Female Non-Binary
I am insured as a dependent
To register as a dependent, please enter the primary policy holder's First Name, Last Name, Regence Member ID#, Date of Birth and Gender. All fields are required.
Date of Birth
Primary Member Gender Gender Male Female Non-Binary
Primary Member Relationship Member Relation Spouse Child Other Adult
To register a spouse or dependent, you must use the primary member's first name, last name, gender, date of birth and Regence Member ID number. Each family member will then create his/her own unique username and passcode. MDLIVE is committed to offering you and your family the best in virtual visits. Each family member must have a separate account as each individual has his/her own unique personal medical record.
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