PAL Application-Register

Submitting Data please wait..

Read this before creating your account: If you have already created an account, do not create another one. Duplicate accounts will be deleted. If you need to change information in your account, sign into the application and click on the "My Account" link on the left side panel.

Please email IAS@hssab.ca if you have any issues with registering.

Requester Registration

Contact Information

Prefix*

First Name*
25 more characters

Middle Name
20 more characters

Last Name*
25 more characters

Suffix

Street1*
120 more characters

Street2
80 more characters

City*
25 more characters

Province*

State (Other)
25 more characters

Postal Code*
10 more characters

Country*

Format: (###)###-####

Phone*
25 more characters

Email Address*
150 more characters

Organization
50 more characters

Confirm Email Address*
150 more characters

Job Title
100 more characters

Default Category*

Language*

Account Information

User Name*
150 more characters

Hint Question*

Hint Answer*
255 more characters

Security Information

Please enter the text shown in the image

Important: This Portal does not accept requests for health information. Please see the Access & Disclosure website for information on how to submit an HIA access request.

The collection of your personal information through this website is legally authorized by section 4(c) of the Protection of Privacy Act ("POPA"). The information will be used or disclosed by Health Shared Services as authorized by POPA, for the purpose of processing and responding to your request. If you have any questions about the collection of your personal information as provided on this form, please contact the Information and Privacy Office by emailing privacy@hssab.ca, or sending your questions in writing by prepaid mail addressed to the attention of Information & Privacy at Seventh Street Plaza 5th Floor North Tower 10030-107 Street Edmonton AB T5J 3E4.