Request a Pro.PrivacEmail Address

Please provide the following information, by copying and pasting the fields into an email message to accounts@privacemail.com or fax it to 604-984-2391 or telephone 1-888-437-2794.

* Agency Name (leave blank if this is a private practice):
* First Name:
* Last Name:
* Credentials: (MA, MSW, PhD) etc:
* Username you are requesting:      @pro.privacemail.com
* Login Password you are requesting:
* Email Address:
* Day-time Phone:                  Ext:
* Evening Phone:                    Ext:
* Birthdate:

Copy and paste the above into an email message and send it to accounts@privacemail.com or fax it to 604-984-2391 or telephone 1-888-437-2794. Please allow two to three business days. Further instructions will be provided by email.