Congratulations on taking the first step in creating your account!

1. Do you have your own work email address at the company offering Benovate? If you do, you're all set! You'll receive an email with set up information on your group's launch date.   

2. No work email address at the company offering Benovate? Fill out the form below with a personal email address. You'll receive a link to verify your account within the next 30 days. 

Every user must use a unique email address for the creation of a Benovate Connect account. This will be your secure username - you cannot share with a spouse, friend or co-worker. 

Your Relationship to Employer *
Name *
Name
Date of Birth *
Date of Birth
Required for security purposes
Address *
Address
If you selected "Employee's Spouse/Dependent" what is the name of the spouse employed at the sponsoring company?
If you selected "Employee's Spouse/Dependent" what is the name of the spouse employed at the sponsoring company?