My Doctors Office

Patient Login | Sign Up | Participating Physicians

Practice Sign Up

Please provide the following information *All fields required unless otherwise noted

Choose a user name and password for this account.
User Name (at least 4 chars)
Password (at least 4 chars)
Verify Password
Practice Information
Contact Name
Contact E-Mail
Address
2nd Address Line (optional)
City
State (select one)
Zip
Phone xxx-xxx-xxxx
Fax (optional)
Business Hours (ex. M-W 8-5, Th. 8-1, etc.)
Insurance Information 250 characters or less (optional)
Information regarding hospitals that this location uses 250 characters or less (optional)
Staff Information 250 characters or less (optional)
Miscellaneous information about this location. 250 characters or less (optional)

A Few Tips

Signing Up...
The information requested represents basic information about your practice. Many of the optional fields, such as Insurance, Hospitals, etc. will be available to your patients through the web site. You may choose to complete these at a later time. After signing up, you may set up a profile for each care provider in the practice.

Cost...
There is a charge of $49.95/mo for each care provider you register with your organization.