Nursing Community Assessment Service

Create Account

Please complete the following:

Your personal information is collected on this form to set up your account with NCAS. Your personal information is collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of your information, please contact the BCCNM Privacy Office at privacy@bccnm.ca.

Email address that you check regularly

Choose password

Confirm password

Security question and answer

Security answer must be at least 6 characters long and not include part of the question.

Security Question

Answer

Current Full Legal Name

First Name

Middle Name

Last Name

Date of Birth (dd/mm/yyyy)

Contact Information

Home Phone

Work Phone (optional)

Cell Phone (optional)

Other Phone (optional)

Home Address

Address Line 1

Address Line 2 (optional)

Address Line 3 (optional)

Country

Province/State

City

Postal/Zip Code

Mailing Address

Different from home address

Address Line 1

Address Line 2 (optional)

Address Line 3 (optional)

Country

Province/State

City

Postal/Zip Code