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Practice Self Assessment Center Registration
Dr. First Name: 
Dr. Last Name: 
License Number: 
Practice Name: 
Tax ID No.: 
Street Address: 
Zip Code: 
Office Phone No.: 
Retype Password: 

Welcome to Metlife’s Practice Self Assessment Center.

Program Applicants: Please complete the following practice registration form.  If your practice has more than one location you will need to select the Add Additional Locations button and complete the information requested for each office. Be sure to enter all the information requested. Once you begin the assessment form you will NOT be allowed to add aditional locations to this assessment.

Note: If the Tax ID Number associated with other offices is different from the primary office location for this assessment you will need to complete a separate assessment. Please do not include those offices as part of this assessment form.

Not enough time to complete the assessment?

You may return to the center and sign-in using the Username and Password entered when registering.