You can get set up for ISDH Gateway in three easy steps! Just enter a user name, primary email, and the application security code, then follow the three steps. Once complete, you will be ready to access your application(s) via ISDH Gateway.

Fields with an (*) indicate they are required.
Before you begin the next three steps, please enter the user name you would like to use, primary email, and the security code for the application your are registering for.

"Security Code" is required for registration. It is a code which identifies the application you will be accessing within ISDH Gateway.
* User Name:
* Security Code:
* Email (Primary):
Organization information is used to identify the organization(s) you belong to. At least one organization is required to register. If the organization can not be found, please send a request for ISDH staff to add it now. Send New Organization Request
Organization Type:
select
Select your organization:
User information is unique criteria which identifies your account and is used to access ISDH Gateway.
* Password:
Confirm Password:

* First:
Middle:
* Last:

Title:
select
License #:
Expiration Date:
RadDatePicker
Open the calendar popup.

Date of Birth:
RadDatePicker
Open the calendar popup.
Driver License #:

Primay contact information is only used to contact you in case of any possible account trouble. (For example, the email you enter will be used to recover/reset your lost account password.) Once registered, contact information can be updated under "My Profile".
Address:
City:
County:
Zip:
Address Type:

* Phone 1:
Type:
Phone 2:
Type:

Email (Secondary):  

Supervisor Information
Name:
Phone:
Email 1:
Email 2:
Application: ----
UserName: ----
First Name: ----
Last Name: ----
Email (Primary): ----
Phone (primary): ----
Organization(s):