Email address The email address is not made public. It will only be used if you need to be contacted about your account or for opted-in notifications. Username Several special characters are allowed, including space, period (.), hyphen (-), apostrophe ('), underscore (_), and the @ sign. Password Confirm password Provide a password for the new account in both fields. Clinic Name Clinic Website Clinic Address Street address Street address line 2 City Province British Columbia Postal code