Genoa Online Request Access Form

Genoa Online access is for partner staff members only. It is not for consumers at this time.
  • This form must be filled out by providers or employees of community mental health organizations (centers) affiliated with Genoa in order to gain access to the Genoa Online tools for the purposes of treatment, payment and operations for consumers under their direct care.
  • A corporate email address must be used to gain access to Genoa Online. If a corporate email address is not available, the exception needs to be explained and approved by the Director of Operations and sent to
  • Passwords must change every 90 days or a user will be locked out of the system until he or she changes the password.
  • The information contained in the Genoa Online tools is protected by the same HIPAA regulations as all other PHI. Please follow the same precautions you would handling this information in any other situation.
  • It is a users’ responsibility to inform Genoa, if they are no longer going to need access to Genoa Online by emailing
Registration errors
Center Information
Account Information
Application Access

As a Genoa Online user, I shall comply with applicable provisions of the Health Insurance Portability and Accountability Act of 1996 and regulations there-under as amended from time to time ("HIPAA").

Genoa Online System Terms of Use
Genoa Website Terms of Use