NEW ACCOUNT SIGNUP
This form is for all new professionals such as doctors, schools, nurses.
If you are a patient/parent please go
HERE
instead.
ALL FIELDS ARE REQUIRED
CHOOSE ACCOUNT TYPE
Doctor or Clinic Staff
School, Teacher, or Nurse
FIRST NAME
LAST NAME
CLINIC or SCHOOL DISTRICT NAME
EMAIL (this is also your USERNAME)
CONFIRM EMAIL
PASSWORD (minimum 8 characters, at least one Uppercase, one Lowercase, one Number, & one Special Char: !, @, #, $, or %)
CONFIRM PASSWORD
If you see this, leave this field blank!
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