SmartZone Account Request Form

Thank you for requesting an account to SmartZone. To create an account for you, we will need you to complete all the fields in the form below. Your new account login name and password will be emailed within 2 business days to the email address provided. If you are requesting more than 5 accounts please email smartzone@pointclickcare.com.

First Name*

Last Name*

Please provide your PointClickCare Login Name (eg. pcc.smithj)*

Role/position:
Please select your role from the drop down list below. We will use this selection to assign the appropriate bundle of training to your account.

Type of Facility:

Email Address:

Facility Name*

Supervisor Email*

Send me a copy of my responses

Email address