Colorado Newborn Screening E-Reports User Access Request Form
This form is intended for healthcare-related facilities and their employees. 
Note, please complete this form using your work-affiliated email address. Upon completion of this form, you will receive a link to e-sign the E-reports Terms of Use Agreement. You will not be granted an account until we receive the signed agreement. Questions? Email cdphe_nbs_software@state.co.us
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Name *
Employee Work Email Address *
Agency/Institution *
Facility Street Address *
Facility City
 *
Facility State
 *
Facility Zip *
Division/Section
Job title *
Supervisor Name *
Supervisor Phone # *
Secret Question for Password Reset *
Answer *
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