Before submitting your request to Connecticut Children’s EpicCare Link system, please read, sign, and attach the Site Agreement Form. If you are a ProHealth/Optum Practice, please use this agreement. If you cannot scan and attach, please fax the signed agreement to 860-837-6082. Without a physical signature on page 6 of the agreement we cannot grant you access. Page 7, Exhibit A, does not need to be filled out when filling out the employee information online. If you currently have access to the Connecticut Children’s EpicCare Link system and are requesting access for a new user please select “Existing Site”. EpicCare Link Type of request * New Site Existing Site Medical Practice / Facility * Site Agreement * Drop a file here or click to upload Choose File Maximum upload size: 52.43MB Providers * Please list all providers for this site. EpicCare Link Administrator Name * Email * Phone * Employee Information Full Name User Type Physician Clinical Support Non-Clinical Credentials and NPI Email Phone Add Remove By selecting this box I agree to the terms and conditions. I Agree If you are human, leave this field blank. Submit Δ