Registration Form

Step One

Click here to read Terms and Conditions of Use Form

Step Two

Click here to read Privacy and Security Commitment Form

*All forms require Adobe Acrobat Reader for viewing and printing. If you do not have this application, you can download it here

Step Three

Please enter the information in the fields below. Please note: You must be a provider or care team member with a treating relationship, or have had previous approval by the HIM department for access, in order to request a login to billingsclinicconnect.com. All applications are subject to approval. All fields are required to be approved for a login.

Name *
Title *	(MD, PA, FNP, RN, LPN, MT, etc.)
Associated Physician(s)	(if not MD or Midlevel)
Clinic/Hospital *
Street Address *
City *
State*
Zip *
Business Phone *
Email Address *

Please check the corresponding box(es) for the Applications for which you will require access below (at least one box must be selected):

	Cerner (CIS): Access to electronic medical records; including lab reference data; Ability to sign verbal orders.
	Electronic Signature Authentication (ESA): Ability to sign transcribed documents electronically for physicians practicing at Billings Clinic or CIS partners only.
	OBLink: Family Birth Center fetal monitoring for physicians practicing at Billings Clinic only.

By electronically signing my name below, I hereby agree that I have read, understand and will adhere to the Terms and Conditions and Privacy and Security Commitments outlined above:

Electronic Signature: *
Spam Prevention: *	What is 2 + 7?

* - Required Field

About BillingsClinicConnect

billingsclinicconnect.com offers a secure and convenient portal, saving you time by having one source for your clinical application needs. Included are tools will help you care for your patients.

If you are a new user and would like to learn more about www.billingsclinicconnect.com, or if you are having difficulty accessing the site with your existing password, call the Help Desk @ 1-866-657-3800 or send an email to helpdesk@billingsclinic.org.