Forgot User ID

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	Forgot User ID * Indicates a required field. Enter the following account information. We will use these values to help identify your account. If we find a match, an email will be sent to your email address on record. User Type User Type is a required field. First Name First Name is a required field. The text field contains invalid characters. Acceptable characters include [a-z], [A-Z], [0-9], spaces and characters [.?!,()-_+';:"/]. Last Name Last Name is a required field. The text field contains invalid characters. Acceptable characters include [a-z], [A-Z], [0-9], spaces and characters [.?!,()-_+';:"/]. Birth Date Birth Date is a required field. Birth Date is not valid or in the correct format. Enter a valid value in the format 'MM/DD/YYYY'. 4-Digit Passcode 4-Digit Passcode is a required field. Delegate Code Delegate Code is a required field. Forgot User ID By completing the Forgot User Id form correctly, We will use these values to help identify your account. If we find a match, an email will be sent to your email address on record. If you did not get any response from us, please call the appropriate phone number: Member – 1-844-245-9580 option 5. Provider Services – 1-800- 999-3371.