HealthSapiens Reseller Application

Instructions for Insurance Brokers: Complete the form below and click "Submit My Registration" to process your application and enable you to sign up customers. Expect a follow-up within 10 mins by email. (Check your Junk/Spam folder if an email doesn't show up within 15 mins.)

Note: If your login credentials don't show up within 15 minutes, go here and request a password reset (you can change your password after you log in.)

Enter Your Information

Your Partner Level Agent
You Can Sign Up Subscribers
Who Pays You HealthSapiens

Required Fields *
I Am... *
Company Name *
First name *
Last name *
Suffix
Display Name *
Mobile Phone *
Address 1 *
Address 2
City *
State *
Zip code *
E-mail *
Confirm e-mail *
Optional Items
Note: Password must be 8-20 characters (letters or numbers only)
Choose A Password
Confirm Password
Time zone
Date of birth
Gender

I have read and agree to the Health Sapiens Terms and Conditions

Check the checkbox and click Submit My Registration to enroll as a HealthSapiens Reseller. We respect your privacy, and will never share your private info without your consent.

Get Started As A Broker Today

Optional Items