Account Registration

Please fill out the following information to create a new portal account. To register as a new portal user, you must obtain an access code from the clinic in person.

Notice: To register as a new portal user you must obtain an access code from the clinic in person. You will enter the access code on the following screen after filling in the field shown here and tapping/clicking on “Register”. Please ensure you have that code before filling in the fields below.

First Name

Middle Name

Last Name

Email Address

Create a user name

Password requires at least 6 characters, consisting of at least 1 capital letter, 1 lower case letter, 1 number, and 1 symbol.

Create a password

Confirm password