Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Filling out this form will generate a welcome letter with your user name and temporary password needed to re-enter your Portal. You may later change your password if you wish. Use the Portal each time you need to contact me or link up for your virtual therapy session. Please also check the Portal for any communications from me.

Patient Type

Patient Information

/ Middle Initial

( optional )
 
( Must be at least 18 yearsz old )
( MM-DD-YYYY )







( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If patient is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )